Brain Under Pressure: Evaluating Effects of Antihypertensive Therapy through White Matter Hyperintensities on Dementia Incidence
Faculty Mentor
Ramaswamy Kannappan
Major/Area of Research
Pharm.D., Cardiology and Neurology
Description
INTRODUCTION: Dementia encompasses a range of neurodegenerative disorders characterized by a decline in cognitive function required for daily life. It is a growing concern as it remains the leading cause of disability and the sixth leading cause of mortality in older adults. High blood pressure is a major risk factor for dementia, and recent studies have explored the connection between cardiovascular and neurological dysfunction, particularly white matter hyperintensities (WMH). The objective of this literature review is to highlight the potential for antihypertensive therapy as an adjunct treatment for dementia.
METHOD: A literature search was conducted to identify relevant articles from 2012 to the present using the PubMed database. Key search terms included dementia, cognitive decline, MRI, cerebrovascular, hypertension, blood pressure control, angiotensin, ACE inhibitors, ARBs, antihypertensive, statins, calcium channel blockers, and WMH, RAAS, diuretics.
RESULTS: The literature review presented findings of Blood-Brain Barrier (BBB) crossing angiotensin II receptor blockers (ARBs) are associated with better memory function and lower incidence of dementia than other antihypertensive drugs, such as ACE inhibitors. Research indicated a lower WMH volume in participants taking BBB-crossing ARBs compared to those taking non-BBB crossing ARBs and ACE inhibitors. These findings are consistent with the mechanism of action of ARBs, which promote angiotensin II binding to angiotensin receptor type 2 sites instead of type 1 sites, reducing the risk of cognitive decline. Another finding was that concomitant use of telmisartan and low dose rosuvastatin had a synergistic effect on lowering WMH volume. Other studies did not conclude that statins alone inhibited WMH progression.
DISCUSSION/CONCLUSION: Results corroborate the various neuroprotective effects of ARBs, including preserved delayed recall memory, processing speed, and verbal fluency. Further research considering genetics and standardized age across comparator groups is needed to conclusively assess ARB efficacy.
Brain Under Pressure: Evaluating Effects of Antihypertensive Therapy through White Matter Hyperintensities on Dementia Incidence
INTRODUCTION: Dementia encompasses a range of neurodegenerative disorders characterized by a decline in cognitive function required for daily life. It is a growing concern as it remains the leading cause of disability and the sixth leading cause of mortality in older adults. High blood pressure is a major risk factor for dementia, and recent studies have explored the connection between cardiovascular and neurological dysfunction, particularly white matter hyperintensities (WMH). The objective of this literature review is to highlight the potential for antihypertensive therapy as an adjunct treatment for dementia.
METHOD: A literature search was conducted to identify relevant articles from 2012 to the present using the PubMed database. Key search terms included dementia, cognitive decline, MRI, cerebrovascular, hypertension, blood pressure control, angiotensin, ACE inhibitors, ARBs, antihypertensive, statins, calcium channel blockers, and WMH, RAAS, diuretics.
RESULTS: The literature review presented findings of Blood-Brain Barrier (BBB) crossing angiotensin II receptor blockers (ARBs) are associated with better memory function and lower incidence of dementia than other antihypertensive drugs, such as ACE inhibitors. Research indicated a lower WMH volume in participants taking BBB-crossing ARBs compared to those taking non-BBB crossing ARBs and ACE inhibitors. These findings are consistent with the mechanism of action of ARBs, which promote angiotensin II binding to angiotensin receptor type 2 sites instead of type 1 sites, reducing the risk of cognitive decline. Another finding was that concomitant use of telmisartan and low dose rosuvastatin had a synergistic effect on lowering WMH volume. Other studies did not conclude that statins alone inhibited WMH progression.
DISCUSSION/CONCLUSION: Results corroborate the various neuroprotective effects of ARBs, including preserved delayed recall memory, processing speed, and verbal fluency. Further research considering genetics and standardized age across comparator groups is needed to conclusively assess ARB efficacy.