Castilla-Guerra Luis, Fernandez-Moreno María del Carmen, Alvarez-Suero Jesús, Jimenez-Hernandez María Dolores
Servicio de Medicina Interna, Hospital de la Merced, E-41640 Osuna, Espana.
Rev Neurol. 2013 Jan 16;56(2):91-100.
Arterial hypertension (AHT) and cognitive problems, especially dementia, are very prevalent among the elderly. AHT is a direct risk factor for vascular dementia and recent studies have shown that it also has repercussions on the prevalence of Alzheimer's disease. Thus, given the fact that there is currently no effective treatment, the prevention of dementia with the aim of delaying or even preventing its appearance is a priority. Moreover, it leads us to pose the question as to whether treating AHT can help prevent dementia. To answer this question, we present a review of the main studies involving interventions with antihypertensive drugs in the prevention of dementia that have been published to date. These trials and meta-analyses suggest that antihypertensive treatment could reduce the risk of dementia by 3-20%, although with no clear statistical significance. However, there are a number of methodological limitations that largely account for the lack of conclusive results in the different intervention studies and which make it possible to deduce that the treatment of AHT does clearly reduce the appearance of dementia. Therefore, clearly further studies on hypertension need to be conducted with the primary aim of appraising the appearance of cognitive impairment or dementia.
动脉高血压(AHT)和认知问题,尤其是痴呆症,在老年人中非常普遍。AHT是血管性痴呆的直接危险因素,最近的研究表明,它对阿尔茨海默病的患病率也有影响。因此,鉴于目前尚无有效的治疗方法,以延缓甚至预防痴呆症发作为目标的痴呆症预防是当务之急。此外,这也促使我们思考治疗AHT是否有助于预防痴呆症。为了回答这个问题,我们对迄今为止发表的关于使用抗高血压药物干预预防痴呆症的主要研究进行了综述。这些试验和荟萃分析表明,抗高血压治疗可使痴呆症风险降低3%至20%,尽管没有明确的统计学意义。然而,存在一些方法学上的局限性,这在很大程度上解释了不同干预研究缺乏确凿结果的原因,也使得我们有可能推断出治疗AHT确实能明显降低痴呆症的发生率。因此,显然需要进一步开展以评估认知障碍或痴呆症发作为主要目的的高血压研究。