The impact of uncontrolled hypertension on the CNS

Česká verzia

Authors: Aleš Tomek
Authors place of work: Neurologická klinika 2. LF UK a FN Motol, Praha
Published in the journal: Vnitř Lék 2023; 69(2): 105-108
Category: Main Topic
doi: https://doi.org/10.36290/vnl.2023.017

Summary

The brain is a target of organ damage due to hypertension. In addition to acute damage in the form of hypertensive encephalopathy, ischaemic stroke, and intracerebral haemorrhage, hypertension causes chronic changes in the brain tissue that, over the course of years, will be manifested by impaired brain functions including cognitive deficit. Hypertension is also a risk factor for progression of cognitive disorder to overt dementia. It is commonly accepted that the earlier in life hypertension occurs, the greater the risk of developing dementia in old age. The pathophysiological mechanism underlying this effect of hypertension is microvascular damage which causes changes in the brain tissue and brain atrophy. A favourable fact is that the treatment with antihypertensive drugs demonstrably reduces the risk of developing dementia in individuals with hypertension. A more profound preventive effect was found in intensive blood pressure control and in RAAS system inhibitors. Therefore, hypertension has to be controlled since its onset, even in younger patients.

Keywords:

dementia – hypertension – Antihypertensive drugs – cognitive deficit – hypertensive brain damage – hypertensive microangiopathy

Zdroje

1. Dawson J, Béjot Y, Christensen LM, et al. European Stroke Organisation (ESO) guideline on pharmacological interventions for long‑term secondary prevention after ischaemic stroke or transient ischaemic attack. Eur Stroke J. 2022;7(3):I‑XLI.

2. Tomek A, et al. Neurointenzivní péče 3. vydání. Praha: Mladá fronta 2018, 608 s.

3. Ungvari Z, Toth P, Tarantini S, et al. Hypertension‑induced cognitive impairment: from pathophysiology to public health. Nat Rev Nephrol. 2021;17(10):639-654.

4. Littlejohns TJ, Collister JA, Liu X, et al. Hypertension, a dementia polygenic risk score, APOE genotype, and incident dementia. Alzheimers Dement. 2022 Apr 19.

5. Suvila K, Lima JAC, Yano Y, Tan ZS, Cheng S, Niiranen TJ. Early‑but Not Late‑Onset Hypertension Is Related to Midlife Cognitive Function. Hypertension. 2021;77(3):972-979.

6. Shang X, Hill E, Zhu Z, et al. The Association of Age at Diagnosis of Hypertension With Brain Structure and Incident Dementia in the UK Biobank. Hypertension. 2021;78(5):1463-1474.

7. Hu YH, Halstead MR, Bryan RN, Schreiner PJ, Jacobs DR Jr, Sidney S, Lewis CE, Launer LJ. Association of Early Adulthood 25-Year Blood Pressure Trajectories With Cerebral Lesions and Brain Structure in Midlife. JAMA Netw Open. 2022;5(3):e221175.

8. Hort J, Rusina R. Paměť a její poruchy. Praha: Maxdorf, 2007, 422 s.

9. Leonenko G, Sims R, Shoai M, et al; GERAD consortium, Hardy J, Escott‑Price V. Polygenic risk and hazard scores for Alzheimer’s disease prediction. Ann Clin Transl Neurol. 2019; 6(3): 456-465.

10. Hughes D, Judge C, Murphy R, et al. Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta‑analysis. JAMA. 2020; 323(19):1934-1944.

11. SPRINT MIND Investigators for the SPRINT Research Group, Nasrallah IM, Pajewski NM, Auchus AP, et al. Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions. JAMA. 2019;322(6):524-534.

12. Miller R. Anesthesia for neurosurgery. In: Firestone L, Lebowitz P, Cook C, eds. Clinical Anesthesia Procedures of Massachusetts General Hospital. 3rd ed. Boston:Little Brown;1988.