Souček Miroslav
Vnitr Lek. 2023 Summer;69(4):249-253. doi: 10.36290/vnl.2023.047.
The brain is among the target organs of hypertension. Patients with hypertension have a higher risk of developing stroke as well as experiencing a decline in cognitive functions and dementia. Changes in the white matter and atrophy of the grey matter of the brain induced by high blood pressure develop insidiously since the onset of hypertension, even in young individuals. The effect of high blood pressure on the vessel wall cumulates in time; therefore, hypertension in younger people implies an increased risk of dementia in older age. Hypertension in young age cannot be considered a benign condition. Hypertension in middle age increases the risk of dementia by 61 %. Consistent and early hypertension control can reverse the adverse development towards dementia and lack of self-sufficiency in the patient. Data comparing individual antihypertensive drugs in terms of preventing dementia are scarce. However, renin angiotensin system blockers have been found to protect against Alzheimer's disease more than other classes of antihypertensive drugs. To achieve rapid and effective hypertension control, a combination of antihypertensive drugs is usually required. Using a fixed-dose triple combination of perindopril, indapamide, and amlodipine, blood pressure targets of < 130/80 mm Hg can be achieved within three months in 93 % of patients.
大脑是高血压的靶器官之一。高血压患者发生中风以及认知功能下降和痴呆的风险更高。高血压引起的脑白质变化和灰质萎缩自高血压发病起就悄然发生,即使在年轻人中也是如此。高血压对血管壁的影响会随着时间累积;因此,年轻人患高血压意味着老年时患痴呆症的风险增加。年轻时的高血压不能被视为一种良性疾病。中年高血压会使患痴呆症的风险增加61%。持续且早期控制高血压可以逆转患者向痴呆症发展的不良趋势以及生活不能自理的状况。关于各种抗高血压药物预防痴呆症效果比较的数据很少。然而,已发现肾素血管紧张素系统阻滞剂比其他类别的抗高血压药物更能预防阿尔茨海默病。为了实现快速有效的高血压控制,通常需要联合使用抗高血压药物。使用培哚普利、吲达帕胺和氨氯地平的固定剂量三联组合,93%的患者可在三个月内将血压目标控制在<130/80 mmHg。