title: Antihypertensives for combating dementia? A perspective on candidate molecular mechanisms and population-based prevention.
abstract: Age-related increases in prevalent dementia over the next 30-40 years risk collapsing medical resources or radically altering the way we treat patients. Better prevention of dementia therefore needs to be one of our highest medical priorities. We propose a perspective on the pathological basis of dementia based on a cerebrovascular-Alzheimer disease spectrum that provides a more powerful explanatory framework when considering the impact of possible public health interventions. With this in mind, a synthesis of evidence from basic, clinical and epidemiological studies indeed suggests that the enhanced treatment of hypertension could be effective for the primary prevention of dementia of either Alzheimer or vascular etiology. In particular, we focus on candidate preventative mechanisms, including reduced cerebrovascular disease, disruption of hypoxia-dependent amyloidogenesis and the potential neuroprotective properties of calcium channel blockers. Following the successful translation of large, long-term and resource-intense trials in cardiology into improved vascular health outcomes in many countries, new multinational prevention trials with dementia-related primary outcomes are now urgently required.
authors: Regenerative Neuroscience Group, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
authors: M
authors: M
authors: Valenzuela
authors: M
authors: M
authors: Esler
authors: K
authors: K
authors: Ritchie
authors: H
authors: H
authors: Brodaty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000517:prevention & control*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications / Q000517:prevention & control; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications / Q000517:prevention & control; D002552:Cerebral Ventricles / Q000473:pathology; D015140:Dementia, Vascular / Q000517:prevention & control*; D004311:Double-Blind Method; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000150:complications / Q000517:prevention & control; D057170:Translational Research, Biomedical
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D018696:Neuroprotective Agents