[Hypertension in the elderly and risk of dementia].

Prevention and treatment of dementia has turned into a major public health challenge. Recent epidemiological studies have shown a significant association between the presence of hypertension and the occurrence of cognitive decline or dementia (including Alzheimer's disease). Indeed, the summation of vascular brain damage and degenerative changes may contribute to an early expression of a still subclinical Alzheimer's disease, causing the threshold of dementia to be reached earlier. Some recent randomized controlled trials (SYST-EUR, PROGRESS, HOPE, SCOPE, HYVET) included cognition as secondary endpoint. Their results open the way for prevention of dementia by antihypertensive treatments. It is therefore necessary that further randomized trials are conducted with the primary objective to assess the impact of antihypertensive treatment on cognitive decline or dementia. In clinical practice, it is important to identify, among hypertensive patients, the subjects at risk for dementia, i.e those who already have mild cognitive impairment or extensive cerebral white matter lesions, in order to optimize blood pressure control and monitor cognitive function (regular cognitive assessment, drugs adherence).