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(Hypertension. 2004;44:612.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Cognitive Impairment and Blood Pressure

Quo Usque Tandem Abutere Patientia Nostra?

From the Study Coordinating Centre, Hypertension Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Belgium, and Erasmus University, Rotterdam, the Netherlands.

Correspondence to Jan A. Staessen, Studiecoördinatiecentrum, Laboratorium Hypertensie, Campus Gasthuisberg, Herestraat 49, B-3000, Leuven, Belgium. E-mail jan.staessen@med.kuleuven.ac.be or jastaessen@netscape.net

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

That hypertension causes vascular dementia is long-established, but that blood pressure behaves as a continuous risk factor for Alzheimer disease continues to bewilder medical experts. The confusion stems from the lengthy latency period between the initiation of the disease and the appearance of symptoms. Moreover, in patients with Alzheimer disease, synaptic disconnection of the autonomic brain nuclei and physical immobilization often lead to a paradoxical fall in blood pressure. Cross-sectional studies, therefore, cannot disclose the true nature of the relation between dementia and blood pressure. Longitudinal studies generated the evidence that hypertension is a harbinger of cognitive impairment. In stroke-free Framingham participants aged 55 to 88 years and followed-up for >20 years,¹ the composite score and measures of attention and memory were independently and inversely correlated with blood pressure at enrollment.¹ Swedish studies of middle-aged men² and septuagenarians,³ followed-up for 15³ to 20² years, confirmed the relation between cognitive impairment^2,3 and blood pressure. This association was tighter in subjects untreated for hypertension than in those treated.² Compared with nondemented controls, blood pressure at follow-up remained elevated in patients with vascular dementia but decreased in patients with Alzheimer disease.³

The incidence of dementia exponentially rises with age with rates of 5 to 10 cases per 1000 person-years at 70 years up to 20 to 40 cases per 1000 person-years at 80 years. With the exception of rare early-onset familial dementia, the medical profession usually views cognitive decline as a problem of the elderly. Here, the work of Elias et al⁴ breaks . . . [Full Text of this Article]

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