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Alzheimer's & Dementia
Dementia Risk Lowered in Elderly by Sustained Blood Pressure
Treatment
Study finds
protection against Alzheimer’s and vascular dementia
April 30, 2006 – Hypertension treatment for senior
citizens age 80 and older has proven successful in providing
protection from cardiovascular problems. but a new study says sustained
treatment may also
reduce the risk of dementia in old age.
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Lead author of the study Rita Peila, Ph.D., an
epidemiologist at the National Institute on Aging (NIA), said “For every
year of hypertension treatment, there is increased protection against
dementia.”
Some physicians hesitate to treat hypertension in
the elderly because of concerns that lowering blood pressure might
impair cognitive functioning. However, clinical trials have shown no
harmful effects on cognitive function in elderly patients undergoing
hypertension therapy.
“Hypertension treatment in the very old — those
aged 80 and older — protects against stroke, heart disease and heart
failure, and now we see that there is no harm — and perhaps a benefit —
on cognitive function,” said Peila, who is also a scientist at the
Pacific Health Research Institute in Honolulu.
The research was reported earlier this month in the
rapid access issue of Stroke: Journal of the American Heart Association.
Researchers analyzed data from the long-term
Honolulu-Asia Aging Study on Japanese-American men born between 1900 and
1919.
They focused on 848 men (ages 50-65) who had
mid-life high blood pressure and were free of dementia at age 77 (on
average). Then, at follow-up visits three and six years later, the men
had a thorough diagnostic evaluation for dementia and took the Cognitive
Abilities Screening Instrument, a well-recognized test of cognitive
function in Japanese and Western populations.
Of the 848 men, researchers identified 142 who had
never been treated for their hypertension and 706 who were being treated
at the age 77 examination. Researchers divided the treated group based
on the duration of treatment:
● 195 men were on medication for less than five
years;
● 149 were treated from five to 12 years; and
● 362 men were treated for more than 12 years prior to the exam.
Researchers found that each year of treatment
reduced the risk of developing dementia during the follow-up period by
about 3 percent.
Compared with men who were never treated for
hypertension, the risk of developing dementia during the follow-up
period was:
● 6 percent lower in those treated less than
five years;
● 48 percent lower in those treated from five to 12 years;
● 60 percent lower in those treated more than 12 years — similar to
the risk in a control group of 446 men with normal blood pressure.
“We found protection against both Alzheimer’s
disease and vascular dementia,” Peila said. “There is more and more
recognition that there is a vascular component to Alzheimer’s disease.”
Long-term hypertension can damage blood vessels of
the brain, and the brains of Alzheimer’s patients often have tiny blood
clots and small infarcts, she said.
While only 7.8 percent of the 848 men were
diagnosed with dementia, even those who did not have dementia showed
cognitive declines. But men who had untreated hypertension had
significantly more cognitive decline than men with normal blood pressure
and hypertensive men treated for at least five years.
“Even if you’re very old, have your blood pressure
checked and talk to your doctor about treatment if it is high,” Peila
said.
In the study, hypertension was defined as:
● 160 mmHg or higher systolic blood pressure
(the pressure when the heart contracts to pump blood to the body); or
● 95 mm Hg or higher diastolic blood pressure (the pressure when the
heart rests between beats).
This cutoff is higher than the current definition
of high blood pressure (140/90 mmHg) but is the same as treatment
guidelines used when the men were first evaluated (from 1965 to 1974).
The study did not assess the type of blood pressure
medications used. Many men had been switched from one type of
medication to another during the lengthy study.
Co-authors are Lon White, M.D., M.P.H.; Kamal
Masaki, M.D.; Helen Petrovitch, M.D.; and Lenore J. Launer, Ph.D.
Researchers were from the NIA, the Pacific Health
Research Institute, and the John A. Burns School of Medicine at the
University of Hawaii at Manoa.
The research was funded in part by the NIA and the
National Heart, Lung, and Blood Institute.
Statements and conclusions of study authors that
are published in the American Heart Association scientific journals are
solely those of the study authors and do not necessarily reflect
association policy or position. The American Heart Association makes no
representation or warranty as to their accuracy or reliability.
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