Hypertension and late-life dementia

In this issue of Neurology ®, two articles discuss the role of hypertension in late-life dementia. One, a clinical-neuropathologic study,1 reports that persons who were treated for hypertension in midlife were less demented clinically and had less Alzheimer disease (AD) pathology than either hypertensive patients who were not treated or nonhypertensive patients. The second article2 was from an epidemiologic study that found that antihypertensive use was associated with a reduction in dementia risk, more so in persons <75 years old. Taken together with the very large body of literature on the relationship of midlife and late-life hypertension to late-life dementia, the findings offer some encouragement for prevention of dementia. Although the two current studies are observational, they complement results from primary prevention trials. While the results are not uniform,3 some large-scale randomized controlled trials of antihypertensive medications have shown reductions in incident dementia or improvements in cognition.4–7 The concordance of observational studies and at least a few clinical trials in antihypertensive treatment is a rare bright spot in the otherwise dismal track record of other putative interventions for …