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Antihypertensive &cognitive impairment

Frank J Wolters, Francesco U S Mattace-Raso, Peter J Koudstaal, Albert Hofman, M Arfan Ikram
BACKGROUND: Orthostatic hypotension (OH) is a common cause of transient cerebral hypoperfusion in the population. Cerebral hypoperfusion is widely implicated in cognitive impairment, but whether OH contributes to cognitive decline and dementia is uncertain. We aimed to determine the association between OH and the risk of developing dementia in the general population. METHODS AND FINDINGS: Between 4 October 1989 and 17 June 1993, we assessed OH in non-demented, stroke-free participants of the population-based Rotterdam Study...
October 2016: PLoS Medicine
Shokei Kim-Mitsuyama
There is accumulating evidence that RAS inhibitors not only reduce blood pressure, but also exert pleiotropic effects, including a renoprotective effect, amelioration of insulin resistance, reduction in onset of diabetes, and suppression of cardiovascular remodelling,. However, the definite benefit of RAS inhibition in treatment of hypertension with CKD or DM is not conclusive. We previously performed the OlmeSartan and Calcium Antagonists Randomized (OSCAR) study comparing the preventive effect of high-dose ARB therapy versus ARB plus CCB combination therapy on cardiovascular morbidity and mortality in 1164 Japanese elderly hypertensive patients with baseline type 2 diabetes and/or CVD (Am J Med (2012))...
September 2016: Journal of Hypertension
Katsuhiko Kohara
The effectiveness of antihypertensive treatment in elderly hypertensive patients has been established through numerous randomized clinical trials including the Hypertension in the Very Elderly Trial (HYVET). However, because of the diversity of biological aging among individuals, chronological age is not the sole determinant for the target blood pressure (BP) level at which antihypertensive medications are aimed. Several conditions, especially frailty, needed be evaluated in managing hypertension among elderly people...
September 2016: Journal of Hypertension
Silvija Mihajlovic, Jeremie Gauthier, Erika MacDonald
BACKGROUND: Adverse drug events (ADEs) occurring in hospital inpatients can have serious implications. The ability to identify and prioritize patients at higher risk of ADEs could help pharmacists to optimize their impact as members of the patient care team. OBJECTIVE: To identify risk factors, patient characteristics, and medications associated with a higher likelihood of ADEs in adult inpatients through an overview of reviews on this topic. DATA SOURCES: Systematic reviews and narrative reviews or guidelines identified through a search of MEDLINE and the Cochrane Database of Systematic Reviews (limited to articles published from 1995 to June 4, 2015), as well as a grey literature search...
July 2016: Canadian Journal of Hospital Pharmacy
Zhongyong Shi, Shifu Xiao, Xia Li
The current case describes a 78-year-old female with two previous episodes of major depression who presented with both symptoms of depression (amotivation and flattened affect) and typical symptoms of dementia (impaired memory and executive functioning). Even after a detailed clinical exam and neuropsychiatric testing, it remained difficult to definitively classify the diagnosis as either treatment-resistant depression or old-age dementia. After 8 weeks of inpatient treatment, including changing her reserpine-based antihypertensive medication, adjusting her antidepressants, and providing psychotherapy, her depressive and anxiety symptoms improved, but most of her cognitive symptoms persisted...
April 25, 2016: Shanghai Archives of Psychiatry
C Lorenzi, E Mossello, E Giuliani, N Nesti, M Bulgaresi, V Caleri, M Pieraccioli, E Tonon, M C Cavallini, C Baroncini, M Di Bari, C A Biagini, N Marchionni, A Ungar
OBJECTIVE: Available data on the prognostic role of blood pressure in older subjects with cognitive impairment are still scarce. We recently showed that tight control of blood pressure may be associated with a greater progression of cognitive impairment in the short term. Aim of this study is to evaluate the long term association of clinical and ambulatory blood pressure (BP) and antihypertensive drugs (AHD) with survival and desease progression in older subjects with cognitive impairment...
September 2016: Journal of Hypertension
Karolina Piotrowicz, Aleksander Prejbisz, Marek Klocek, Roman Topór-Mądry, Paulina Szczepaniak, Kalina Kawecka-Jaszcz, Krzysztof Narkiewicz, Tomasz Grodzicki, Andrzej Januszewicz, Jerzy Gąsowski
BACKGROUND: Blood pressure (BP) control in the elderly is often limited by poor compliance with prescribed regimen. Both can be influenced by clinical cognitive or mood impairments; however, the impact of subclinical alterations of cognition or mood remains unknown. OBJECTIVES: To assess the relation between cognition, mood, and BP control in treated older hypertensive patients. DESIGN: Cross-sectional association study. SETTING: Predefined substudy to the POLFOKUS nationwide survey investigating the correlates of poor BP control in patients randomly drawn from primary and specialist practices across Poland...
September 1, 2016: Journal of the American Medical Directors Association
Sevil Yasar, Mattan Schuchman, Jean Peters, Kaarin J Anstey, Michelle C Carlson, Ruth Peters
PURPOSE OF REVIEW: There is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer's disease; however, associations between antihypertensive medications (AHMs) and dementia risk are less consistent. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews are comprehensive. Our extensive review includes 15 observational and randomized controlled trials (RCTs) published over the last 5 years, assessing the relationship between AHM and cognitive impairment...
August 2016: Current Hypertension Reports
Ruth Peters, Mattan Schuchman, Jean Peters, Michelle C Carlson, Sevil Yasar
PURPOSE OF REVIEW: There is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer's disease; however, associations between antihypertensive medications (AHM) and dementia risk are less clear. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews provide comprehensive review. Our extensive review includes 24 mechanistic animal and human studies published over the last 5 years assessing relationship between AHM and cognitive function...
August 2016: Current Hypertension Reports
Alberto J Espay, Peter A LeWitt, Robert A Hauser, Aristide Merola, Mario Masellis, Anthony E Lang
Neurogenic orthostatic hypotension and supine hypertension are common manifestations of cardiovascular dysautonomia in Parkinson's disease and related synucleinopathies. Because these disorders are haemodynamic opposites, improvement in one might be achieved at the expense of worsening of the other. Thus, management decisions necessitate assessment of the individual risks for patients with coexistent neurogenic orthostatic hypotension and supine hypertension. Whereas neurogenic orthostatic hypotension poses risks for falls and can be associated with cognitive impairment in the short term, chronic supine hypertension can be associated with stroke and myocardial infarction in the long term...
August 2016: Lancet Neurology
Xiaoqing Bu, Yonghong Zhang, Lydia A Bazzano, Tan Xu, Libing Guo, Xuemei Wang, Jintao Zhang, Yong Cui, Dong Li, Fengshan Zhang, Zhong Ju, Tian Xu, Chung-Shiuan Chen, Jing Chen, Jiang He
BACKGROUND: The effect of early blood pressure reduction on cognitive function in patients with acute ischemic stroke remains unknown. AIM: We tested whether antihypertensive treatment would reduce cognitive impairment in patients with acute ischemic stroke. METHODS: In the China Antihypertensive Trial in Acute Ischemic Stroke, patients with elevated blood pressure were randomly assigned to receive antihypertensive treatment or to discontinue all hypertensive medications within 48 h of onset...
July 13, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Enrico Mossello, David Simoni
High blood pressure and cognitive impairment often coexist in old age, but their pathophysiological association is complex. Several longitudinal studies have shown that high blood pressure at midlife is a risk factor for cognitive impairment and dementia, although this association is much less clear in old age. The effect of blood pressure lowering in reducing the risk of dementia is only borderline significant in clinical trials of older subjects, partly due to the insufficient follow-up time. Conversely, dementia onset is associated with a decrease of blood pressure values, probably secondary to neurodegeneration...
2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Adiukwu Frances, Ofori Sandra, Ugbomah Lucy
Over the past two decades, the term vascular cognitive impairment (VCI) has been used to refer to a spectrum of cognitive decline characterized by executive dysfunction, associated with vascular pathology. With 30% of stroke survivors showing cognitive impairments, it is regarded as the most common cause of cognitive impairment. This is a narrative review of available literature citing sources from PubMed, MEDLINE and Google Scholar. VCI has a high prevalence both before and after a stroke and is associated with great economic and caregiver burden...
June 22, 2016: World Journal of Psychiatry
Katalin R Czuriga-Kovács, Dániel Czuriga, László Csiba
Hypertension is one of the most important modifiable risk factors of cardioand cerebrovascular diseases, responsible for the development of severe target organ damages. It has been shown that hypertension is associated with an increased prevalence of cognitive decline. It negatively affects the cognitive battery and accelerates dementia. Beside the known detrimental effects of senile hypertension on cognitive performance in the elderly population, previous studies pointed out that young, hypertensive individuals may also suffer from hypertension related changes in their cognitive capacity...
2016: CNS & Neurological Disorders Drug Targets
Matthieu Lilamand, Jean-Sébastien Vidal, Matthieu Plichart, Laura W De Jong, Emmanuelle Duron, Olivier Hanon
OBJECTIVES: Hypertension is a risk factor for cognitive impairment and dementia. Arterial stiffness could be involved in the mechanisms of vascular cognitive impairment and in Alzheimer's disease. We examined the association between arterial stiffness, assessed by carotid-femoral pulse wave velocity (PWV), and medial temporal lobe (MTL) atrophy, a biomarker of Alzheimer's disease. METHODS: Elderly community-dwelling study participants (n = 149) with memory complaints were diagnosed with Alzheimer's disease (n = 62) or mild cognitive impairment (n = 87) at a memory clinic...
July 2016: Journal of Hypertension
Daniele Lo Coco, Gianluca Lopez, Salvatore Corrao
We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer's disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates...
2016: Vascular Health and Risk Management
Joanna M Moryś, Grzegorz M Kozera, Jolanta Neubauer-Geryk, Piotr Kruszewski, Bogumił Wolnik, Walenty M Nyka, Leszek Bieniaszewski
OBJECTIVE: We aimed to assess a wide range of cognitive functions in patients with type 1 diabetes (DM1) compared with healthy control subjects and to evaluate the effects of statins on cognitive functions in DM1 patients. MATERIALS AND METHODS: The sample studied consisted of 55 DM1 patients (80.0% with hyperlipidemia, 20% with statin treatment) and 36 age-matched control subjects (77.8% with hyperlipidemia) without diabetes or statin use. Their cognitive functions (attention, memory, and executive functions) were evaluated with the trail making test, controlled oral word association test (COWAT), Rey-Osterrieth complex figure test, brain damage test (diagnosticum für cerebralschädigung, DCS), Wisconsin card sorting test (WCST), and digit span and block design tests from the revised Wechsler adult intelligence scale...
July 2016: Clinical Neuropharmacology
Taro Kojima, Masahiro Akishita
Many drugs have been reported to induce not only delirium but also cognitive impairment. Some types of drugs are reported to induce dementia, and prolonged hypotension or hypoglycemia induced by overuse of antihypertensive drugs or oral antidiabetic drugs could result in dementia. Recently, taking multiple drugs with anticholinergic activity are reported to cause cognitive decline and anticholinergic burden should be avoided especially in patients with dementia. Drug-induced dementia can be prevented by avoiding polypharmacy and adhering to the saying 'start low and go slow' ...
March 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
I Riba-Llena, C Nafría, X Mundet, A López-Rueda, I Fernández-Cortiñas, C I Jarca, J Jiménez-Balado, M Domingo, J L Tovar, F Orfila, F Pujadas, J Álvarez-Sabín, O Maisterra, J Montaner, P Delgado
BACKGROUND AND PURPOSE: Enlarged perivascular spaces (EPVS) have been recently considered a feature of cerebral small vessel disease. They have been related to aging, hypertension and dementia but their relationship with hypertension related variables (i.e. target organ damage, treatment compliance) and mild cognitive impairment (MCI) is not fully elucidated. Our aims were to investigate the relation between basal ganglia (BG) and centrum semiovale (CSO) EPVS with vascular risk factors, hypertension related variables and MCI...
June 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Meral Demir, Ali Osman Gürol, Raşit Tolga Özyiğit, Ali Yağz Üresin
PURPOSE: Hypertension is a risk factor for cognitive impairment (CI). However, the specific effect of antihypertensive therapy on cognitive function is still controversial. We aimed to investigate the effect of antihypertensive agents targeting the renin-angiotensin system (RAS) on CI and brain-derived neurotropic factor (BDNF). METHODS: We included 62 patients who had been using the same antihypertensive agent for at least 3 months. Patients who had relevant conditions that could contribute to CI were excluded...
June 2016: Journal of Cardiovascular Pharmacology
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