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    Hypertension, Target Organ Injury, and the Brain

    Do elevated blood pressures lead to cognitive dysfunction?

     

    Answers: Options B and C are true.

    Results from the study in option A1 found the risk of cognitive impairment at 4 years was not slightly but rather was substantially increased—2.8 times—in those participants with hypertension. Also in that study, the risk of cognitive impairment was increased 4.3 times in the those with hypertension who were untreated versus 1.9 times in those individuals who were treated (option B).1

    Results of the study referenced in option C2 show an equally remarkable difference in the incidence of dementia between older persons with hypertension treated and untreated for the disease.2

    The bottom line: cognitive regions of the brain do indeed appear to be susceptible to injury from elevated blood pressure.

    The follow-on question to be explored is what specific injury is incurred by cognitive centers in the brain as a consequence of hypertension?

    The answer is not known at this time, but research is ongoing and has scientific direction. The primary suspicion is that hypertension, manifested as a variety of small-vessel diseases, damages the cerebral microcirculation.3 Theories about the specific mechanism of the injury include disruption of the blood brain barrier, interference in the connections between neurons and their blood supply, as well as direct capillary damage.3 Other studies have identified that specific small vessel injuries –senile plaques and neurofibrillary tangles—are increased in persons with hypertension.4

    Although there is conflicting evidence on the impact of antihypertensive therapy on the prevention of dementia, there are some promising studies. How familiar are you with the data?

    2. Of the following statements, which is/are true and which false?  

    A. The use of antihypertensive agents significantly reduced the risk of Alzheimer disease in persons with higher baseline blood pressures than controls.

    B. Regarding specific agents used to treat hypertension in older adults, the use of diuretics at baseline in patients age ≥ 75 years reduced the prevalence of dementia on follow up more than in those individuals not taking diuretics.

    C. Patients with dementia at baseline who were not taking diuretics experienced a 2-fold faster rate of dementia progression as assessed by Mini-Mental State Examination than those taking diuretics.

    Please click here for answer and discussion.

    Gregory W. Rutecki, MD
    Dr Rutecki is with the Cleveland Clinic National Consultation Service.

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      What is it about HCTZ that other antihypertensives lack that helps to decrease dementia?