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(Hypertension. 2004;44:20.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Preventing Dementia by Treating Hypertension and Preventing Stroke

From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada.

Correspondence to Dr David Spence, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, 1400 Western Rd, London, ON, Canada N6G 2V2. Email dspence@robarts.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In this issue of Hypertension, Korf et al¹ report from the Honolulu Asia Aging Study that untreated hypertension was significantly associated with hippocampal atrophy. They had previously shown that untreated hypertension was associated with midlife cognitive decline² and with Alzheimer disease and vascular dementia.³

This new finding strengthens the value of hippocampal atrophy as an early predictor of cognitive decline. It also adds importantly to a growing body of evidence that hypertension and stroke beget dementia and that treatment of hypertension, as well as prevention of stroke, prevents dementia. In the past this might have been explained by a reduction of vascular dementia, but it is apparent that the lines between vascular dementia and Alzheimer disease are becoming blurred.

Hypertension is strongly associated with the subsequent development of dementia. In Linxiang County, China, high blood pressure was shown in multiple logistic regression to be a risk factor for Alzheimer disease (OR 1.97), with a significant dose–response relationship.⁴ Skoog et al⁵ found that subjects who developed dementia at 79 to 85 years of age had significantly higher blood pressures 15 years earlier. It seems likely that the relationship between hypertension and dementia is via stroke, because stroke is also associated with increased risk of dementia.

In the Framingham study, stroke doubled the incidence of dementia, and the hazard ratio was even greater at 2.6 for younger subjects.⁶ In North Manhattan, the relative risk for Alzheimer disease was 1.6 for those with stroke, and this increased with addition of vascular risk . . . [Full Text of this Article]