Tentative conclusions and future prospects
There is no doubt that high blood pressure is associated with cognitive deterioration and dementia, independently of the occurrence of a stroke. Conflicting results come in part from the various ways of testing cognition and defining cognitive decline, and the lack of precisely diagnosing dementia in its early stage. Another, and yet unsolved, issue is the modification of this relationship with age. It is likely that the risk of cognitive deterioration related to high blood pressure decreases with increasing Inhibitors,research,lifescience,medical age. A similar modification of the risk with age is observed in the relationship between hypertension and stroke. Further, there appears to be spontaneous lowering of blood pressure at the advanced stage of dementia, probably Inhibitors,research,lifescience,medical through neuronal depopulation in the centers regulating blood pressure, which renders the relationship even more complex. Finally, the true relative risk of dementia associated with hypertension is probably relatively modest compared with other stronger risk factors for dementia like age, education, and the ApoE polymorphism. Therefore, some degree of fluctuation is not unexpected when estimating Inhibitors,research,lifescience,medical this risk, and some of the controversial results could thus be selleck inhibitor explained. Despite these difficulties, clarifying
this relationship remains of major importance. With the ageing of our societies, we are facing an epidemic of dementia for which
we have no curative or preventive treatment. In this Inhibitors,research,lifescience,medical context, even a modest reduction in the risk would have important consequences. Moreover, even if high blood pressure is associated with a moderate relative risk of dementia, its very high prevalence means that the risk of dementia attributable to high blood pressure may be high, and that improved control of hypertension may translate into a dramatic reduction in the number of cases of dementia.95 Unanswered questions What is the true magnitude of the relationship? The data are still insufficient, Inhibitors,research,lifescience,medical and we definitively need more population-based studies in the elderly in order to accurately estimate the risk of dementia attributable to high blood pressure and other vascular factors. Some of the existing large population-based studies in this domain should also combine their efforts with a view to producing an exact measure of this risk. Is it possible to identify individuals Rebamipide or groups at high risk? It is likely that the effect of high blood pressure on the brain varies dramatically between individuals, even among hypertensive patients. Those at high risk of hyper-tension-related cognitive decline or dementia would benefit the most from accurate control of their hypertension. Again, these high-risk groups can be properly identified only in large observational studies with a long follow-up.