Hypertension

Investigating clinical records from a fairly large population during 1960-1974, Kokmen and collaborators (Kokmen et al., 1991) have shown that out of the 20 risk factors studied, hypertension along with episodic depression and personality disorders were the only risk factors to have statistically significant associations for potential clinical risk factor to develop AD. Since then, there have been a number of extensive studies largely supporting the notion that hypertension is an important risk factor for AD. However, the mechanistic interactions between hypertension and the AD neuropathology are far from clear. For a discussion on these interactions, the reader could consult a recent review by Skoog and Gustafson (Skoog & Gustafson, 2006).

There is no antihypertensive therapeutic strategy for the prevention of AD at the present time. Furthermore, hypertension as a target is complicated by the observation that blood pressure often falls when AD is clinically diagnosed (Birkenhager & Staessen, 2006). However, the treatment of hypertension is advisable for midlife high blood pressure, and in particular, low diastolic pressure and very high systolic pressure, which shows a high association with subsequent development of dementia and Alzheimer's disease. Unfortunately, randomized clinical trials have not provided strong evidence for a protective role of antihypertensives to prevent dementia and stroke-related cognitive decline (Qiu, Winblad, & Fratiglioni, 2005).

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