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Arterielle Hypertonie und Demenz

Arterial hypertension and dementia

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Zusammenfassung

Die arterielle Hypertonie (AH) gilt als beeinflussbarer Risikofaktor für vaskuläre Demenzformen (VD) und wahrscheinlich auch für die Alzheimer-Demenz (AD). Die folgende Arbeit gibt eine Übersicht über die Ergebnisse der größeren prospektiven Studien zu dieser Thematik. Die Studienergebnisse werden auf der Basis pathophysiologischer Theorien kritisch kommentiert. Vor dem Hintergrund z. T. inkonsistenter oder widersprüchlicher Befunde ist festzustellen, dass die Zusammenhänge zwischen AH und Demenz bislang nur unzureichend verstanden sind. Unter therapeutischen Gesichtspunkten gilt einstweilen die einfache Regel: AH behandeln, Ziel sollte Normotonie sein! Bis zur Widerlegung einer J-förmigen Beziehung zwischen Blutdruck und kognitiver Dysfunktion sollte weiterhin Vorsicht vor zu forcierter Blutdrucksenkung geübt werden. Die Überlegenheit einer bestimmten Substanz unter demenzprophylaktischen Aspekten ist nicht zu belegen.

Summary

Arterial hypertension (AH) is considered to be an important risk factor for vascular cognitive impairment and probably for Alzheimer’s disease, too. In the current review we provide an overview of the major prospective clinical trials on this issue. With respect to the inconsistent findings of these studies one must state that the interrelations between AH and dementia are still incompletely understood. Regarding therapy there thus is a simple rule: AH should be treated until normal blood pressure values are reached. As long as the hypothesis of a J-curve between blood pressure and cognitive dysfunction has not been disproved, overaggressive blood pressure lowering cannot be recommended. Regarding the aim of preventing dementia, there is no evidence for the superiority of a specific antihypertensive treatment regimen.

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  1. Tagesklinik für kognitive Neurologie, Max-Planck-Institut für Kognitions- und Neurowissenschaften, Universität Leipzig

    R. Scheid

  2. Medizinische Klinik I, Fachbereich Kardiologie und Angiologie, Universität Leipzig

    H. Voigt

  3. Tagesklinik für kognitive Neurologie, Universität Leipzig, Liebigstraße 22a, 04103, Leipzig

    R. Scheid

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Nachtrag bei der Korrektur

Die Autoren möchten auf eine weitere aktuelle Observationsstudie hinweisen, die nach Fertigstellung des Manuskriptes erschienen ist und deren Ergebnisse gut mit den hier vorgetragenen Bewertungen kompatibel sind: Herbert LE, Scherr A, Bennett DA et al. (2004) Blood pressure and late-life cognitive function change. A biracial longitudinal population study. Neurology 62:2021–2024

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Scheid, R., Voigt, H. Arterielle Hypertonie und Demenz . Nervenarzt 76, 143–153 (2005). https://doi.org/10.1007/s00115-004-1787-3

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