Division of Geriatrics, Israelite Hospital, Rome, Italy.
Department of Geriatrics, Institute of Psychiatry and Psychology, Neuroscience and Orthopedics, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy.
Minerva Cardiol Angiol. 2022 Jun;70(3):285-297. doi: 10.23736/S2724-5683.20.05452-3. Epub 2020 Dec 1.
Cognitive decline and dementia recognize multiple risk factors and pathophysiological mechanisms, often involved simultaneously with complex interactions. Several studies have shown that both arterial hypertension and hypotension are associated with a greater risk of cognitive decline and dementia, but clinical evidence on this point is conflicting. Our aim was to conduct an umbrella review on cognitive function, dementia, and blood pressure, with particular attention to epidemiological, prognostic and therapeutic aspects.
We conducted a dedicated literature search on PubMed for systematic reviews and meta-analyses that focused on arterial pressure, hypertension, hypotension and similar conditions, and cognitive function, cognitive decline and dementia. The internal validity of systematic reviews and meta-analyses was formally analyzed using the OQAQ tool. The umbrella review was planned in accordance with current international recommendations and was described as specified by the PRISMA guidelines.
Seventeen systematic reviews (including 13 meta-analyses) were included, for a total of 675 clinical studies and over 1 million patients. Hypertension results to be associated with a lower risk of Alzheimer's dementia, greater risk of vascular dementia and greater risk of cognitive decline. Orthostatic hypotension seems to be associated with greater risk of Alzheimer's dementia, vascular dementia and dementia of Parkinson's disease. Therapy with acetylcholinesterase inhibitors produces lower risk of cardiovascular events, greater risk of hypertension and greater risk of bradycardia, while the anti-hypertensive therapy leads to a lower risk of dementia of all types and lower risk of cognitive decline.
To date, the evidence on the relationship between blood pressure, cognitive decline and dementia provides somewhat heterogeneous data. Further studies are clearly needed, with explicit inclusion criteria as objective as possible, adequate follow-up and precise characterization of implemented cardiovascular and cognitive treatments.
认知衰退和痴呆症可识别多种风险因素和病理生理机制，这些因素通常同时涉及复杂的相互作用。多项研究表明，高血压和低血压都与认知衰退和痴呆的风险增加相关，但这方面的临床证据存在矛盾。我们的目的是对认知功能、痴呆症和血压进行伞式综述，特别关注流行病学、预后和治疗方面。
我们在 PubMed 上进行了专门的文献检索，以查找重点关注动脉压、高血压、低血压和类似情况以及认知功能、认知衰退和痴呆症的系统评价和荟萃分析。使用 OQAQ 工具对系统评价和荟萃分析的内部有效性进行了正式分析。伞式综述按照当前国际建议进行规划，并按照 PRISMA 指南的规定进行描述。
共纳入 17 项系统评价（包括 13 项荟萃分析），共计 675 项临床研究和超过 100 万例患者。高血压与阿尔茨海默病痴呆风险降低、血管性痴呆风险增加和认知衰退风险增加相关。直立性低血压似乎与阿尔茨海默病痴呆、血管性痴呆和帕金森病痴呆的风险增加相关。乙酰胆碱酯酶抑制剂治疗可降低心血管事件风险，增加高血压风险和心动过缓风险，而抗高血压治疗可降低所有类型痴呆症和认知衰退的风险。
迄今为止，关于血压、认知衰退和痴呆症之间关系的证据提供了一些不一致的数据。显然需要进一步的研究，明确纳入尽可能客观的标准、足够的随访和对实施的心血管和认知治疗的精确描述。
