Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK.
J Cereb Blood Flow Metab. 2023 Oct;43(10):1800-1802. doi: 10.1177/0271678X221133473. Epub 2022 Oct 25.
Hypertension is associated with both ageing and dementia. Despite this, optimal blood pressure targets in dementia remain unclear. Both high and low blood pressure are associated with poorer cognition. Changes in vascular physiology in dementia may increase the vulnerability of the brain to hypoperfusion associated with antihypertensives. We discuss the potential risks of antihypertensives in the context of altered cerebral haemodynamics, and evidence from antihypertensive trials in dementia. We suggest that individualised blood pressure targets should be the focus for antihypertensive therapy in dementia, rather than strict control to uniform targets extrapolated from trials in cognitively healthy individuals.
高血压与衰老和痴呆都有关。尽管如此，痴呆症患者的最佳血压目标仍不清楚。高血压和低血压都与认知能力下降有关。痴呆症患者血管生理的变化可能会增加大脑对与降压药相关的灌注不足的脆弱性。我们讨论了改变大脑血液动力学的情况下降压药的潜在风险，以及痴呆症降压试验的证据。我们建议，在痴呆症中，降压治疗的重点应该是个体化的血压目标，而不是从认知健康个体的试验中推断出来的严格控制到统一目标。
