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Treating hypertension could offer cognitive boon
15 February 2010
MedWire News: Treating hypertension could prevent a third of patients with isolated executive dysfunction from progressing to dementia, show findings from the Canadian Study of Health and Aging.
“Control of hypertension in this population could decrease by one-half the projected 50% 5-year rate of progression to dementia,” say Shahram Oveisgharan and Vladimir Hachinski (University of Western Ontario, London, Canada).
Hypertension did not influence progression to dementia in patients with baseline memory impairment, in isolation or in association with executive cognitive impairment, but the researchers say that this state is more usually associated with progression to Alzheimer’s disease.
Oveisgharan and Hachinski studied 990 participants in the Canadian Study of Health and Aging, aged an average of 83 years, who were followed-up for 5 years. Among 532 of the participants, 24.6% had normal memory and executive function, while the others had cognitive impairment, no dementia (CIND), comprising 31.1% with executive dysfunction only, 29.5% with memory dysfunction only, and 14.8% with both conditions.
Two-thirds of the whole cohort had hypertension, the researchers report in the Archives of Neurology. Among participants with CIND, 59.5% of those with hypertension and 64.2% without progressed to dementia.
But hypertension affected dementia risk differently among the subgroups of CIND; among people with executive dysfunction only, 57.7% of those with hypertension versus just 28.0% of those without progressed to dementia (p<0.05).
In contrast, similar proportions of hypertensive and normotensive people with memory dysfunction only progressed to dementia, at 67.1% versus 74.2%, respectively, and the corresponding rates for people with both executive and memory dysfunction were 70.9% versus 68.7%.
The association between hypertension and progression to dementia remained significant after the team excluded people with a history of stroke.
“This study may have profound implications for community dwellers with CIND,” say Oveisgharan and Hachinski.
“Worldwide, neurologic disorders are the most frequent cause of disability-adjusted life-years; among these, cerebrovascular disease is the most common risk factor, and dementia is the second most common. There is no preventive or therapeutic intervention to mitigate this public health burden.”
They conclude: “We show herein that the presence of hypertension predicts progression to dementia in a subgroup of about one-third of subjects with CIND.”
