Purpose: Both hypertension and cognitive impairment are common disorders in old people. This paper reviews epidemiological, clinical and experimental studies that have examined the association between these conditions.
Contents: Evidence is presented which suggests that raised blood pressure levels contribute to cognitive impairment in susceptible people, particularly those with concomitant conditions which predispose them to cerebral ischemia. Some studies have demonstrated that certain classes of antihypertensive drugs may have beneficial actions on ischaemic and cell growth processes, while others may tend to impair cognitive function, either by central actions or by alterations to cerebral blood flow.
Conclusions: A successful approach to the treatment of hypertension-associated cognitive impairment is likely to follow a detailed analysis of risk factors in the individual patient. Fundamental epidemiological work is required to clarify genetic components or risk, and more long-term treatment trials would also be helpful, although these have proved problematic in the elderly. At present, although it is clear that old people with hypertension should be treated, whether or not they are also cognitively impaired, further studies are necessary to decide on the best antihypertensive therapy for this substantial population.