Antihypertensive agents for aging patients who are at risk for cognitive dysfunction

Observational and experimental data continue to accumulate about the impact of blood pressure (BP) and antihypertensive agents on cognitive function. Current evidence suggests that there is a U-shaped association between BP earlier in life and poor cognitive function and clinical dementia, including Alzheimer's disease. This association has been identified more consistently in longitudinal surveys due to the fact that BP declines when cognitive symptoms start. Lowering BP provides protection against this complication of high BP. This effect is present in the cognitively intact and in those with dementia. Antihypertensives that cross the blood brain barrier and affect the renin-angiotensin-aldosterone system (such as perindopril or losartan) or brain calcium metabolism (nitrendipine) provide additional protection beyond BP control against cognitive decline. These drugs may be preferred in such clinical situations.