Antihypertensive treatment in elderly hypertensives without a history of stroke and the risk of cognitive disorders.
OBJECTIVE
The role of the antihypertensive therapy in preventing cognitive disorders in elderly persons without a history of stroke is a matter of debate. This review focuses on the pathogenesis of the cognitive disorders in elderly hypertensives and on the risk factors of their occurrence.


METHODS
Relevant papers were identified by searches in PubMed from 1946 until October 2007, using the key words 'vascular risk factors', 'vascular cognitive impairment', 'vascular dementia', 'neuroimaging in hypertension' and 'antihypertensive treatment'.


RESULTS
Blood pressure lowering in elderly patients with long-standing hypertension below a certain critical level may increase the risk of cerebral hypoperfusion and cognitive decline, particularly in cases with additional vascular risk factors. Cerebral white matter lesions have been found in the majority of elderly hypertensives. They have been shown to correlate with cognitive disorders.


CONCLUSIONS
Appropriate neuropsychological assessment and follow-up of the cognitive functions could be considered with the aim to individualize the antihypertensive therapy and slow down cognitive decline. Prospective studies are needed to confirm such a treatment strategy.
Hadjiev
D I
DI
University Hospital of Neurology and Psychiatry St. Naum, Medical University, Sofia, Bulgaria. dimiter_hadjiev@hotmail.com
Mineva
P P
PP
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001921:Brain / Q000098:blood supply / Q000187:drug effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003072:Cognition Disorders / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D012307:Risk Factors; D020521:Stroke / Q000150:complications
D000959:Antihypertensive Agents