Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
J Alzheimers Dis. 2012;32(3):753-63. doi: 10.3233/JAD-2012-120613.
Epidemiological studies suggest an association between chronic blood pressure (BP) changes and Alzheimer's disease (AD). In particular, there is growing evidence that hypertensive people that do not have their BP adequately treated and controlled in midlife are more likely to develop AD in late-life. It has been hypothesized that cerebrovascular disease is a common pathway which connects hypertension and AD in individuals with apolipoprotein E genotype through brain hypoperfusion and hypoxia. This could accelerate amyloid-β aggregation that disrupts cell-to-cell connectivity and leads to eventual brain neuron loss. Also, high BP contributes to worsen AD by raising oxidative stress and inflammatory response. Aging-related structural and functional disturbances appear to exacerbate the deleterious effect of chronic hypertension on cerebral blood flow autoregulation. There is evidence suggesting that some antihypertensive drug classes reduce the risk and progression of AD more than others. Further prospective randomized studies comparing different classes of antihypertensive drugs are needed to provide more evidence regarding their effects on AD risk. Hypotension could be a consequence of the incident dementia and conversely deteriorate the outcome of AD by worsening brain hypoperfusion. Frequent home BP monitoring should be carried out in AD patients to detect harmful orthostatic hypotension.
流行病学研究表明，慢性血压（BP）变化与阿尔茨海默病（AD）之间存在关联。特别是，越来越多的证据表明，中年人血压得不到充分治疗和控制的高血压患者在晚年更有可能患上 AD。有人假设，通过脑灌注不足和缺氧，脑血管疾病是连接具有载脂蛋白 E 基因型的高血压和 AD 的共同途径。这可能会加速淀粉样蛋白-β的聚集，破坏细胞间的连接，最终导致脑神经元的丧失。此外，高血压会通过增加氧化应激和炎症反应而加重 AD。与年龄相关的结构和功能障碍似乎会加剧慢性高血压对脑血流自动调节的有害影响。有证据表明，一些降压药类比其他药物更能降低 AD 的风险和进展。需要进一步进行前瞻性随机研究，比较不同类别的降压药物，以提供更多关于它们对 AD 风险影响的证据。低血压可能是偶发痴呆的结果，相反，通过加重脑灌注不足，使 AD 的预后恶化。应在 AD 患者中进行频繁的家庭血压监测，以检测有害的直立性低血压。
