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Neurologic consequences of hypertension and antihypertensive drug therapy
1Department of Cell Biology, University of Alabama at Birmingham 35294-0019.
Insights
Antihypertensive drugs can improve cognitive function in hypertensive patients, particularly learning and memory. Angiotensin-converting enzyme inhibitors show the most consistent benefits, alongside some beta-blockers and calcium channel blockers.
Area of Science:
- Cardiovascular Medicine
- Neuroscience
- Pharmacology
Background:
- Essential hypertension untreated leads to severe cardiovascular and renal disease and stroke.
- Hypertension negatively impacts cognitive functions, including learning and memory.
- The effect of antihypertensive drugs on cognitive function is not fully understood.
Purpose of the Study:
- To evaluate the impact of antihypertensive drugs on cognitive function in hypertensive patients.
- To identify which classes of antihypertensive drugs may benefit cognition.
- To explore the theoretical basis for drug-induced cognitive improvements.
Main Methods:
- Review of recent studies on antihypertensive drugs and cognition in hypertensive patients.
- Analysis of clinical and animal studies investigating the role of angiotensin-converting enzyme in cognitive function.
- Comparison of cognitive effects across different antihypertensive drug classes.
Main Results:
- No current antihypertensive drugs show major deleterious effects on cognition.
- Angiotensin-converting enzyme inhibitors consistently improve cognitive function in hypertensive patients.
- Beta 1-adrenergic receptor blockers and certain calcium channel blockers also show cognitive benefits.
Conclusions:
- Antihypertensive therapy can ameliorate cognitive dysfunction associated with hypertension.
- Angiotensin-converting enzyme inhibitors are particularly effective in enhancing cognitive function.
- The role of cerebral angiotensin-converting enzyme in learning and memory supports these findings.
Abstract:
Untreated essential hypertension leads to cardiovascular and renal disease and stroke, but antihypertensive drug therapy effectively reduces these consequences of hypertension. Several studies indicate that hypertension can negatively impact on cognitive function, especially on learning and memory, but the ability of antihypertensive drugs to ameliorate these cognitive dysfunctions is less clear. None of the recent studies convincingly demonstrates that any of the antihypertensive drugs currently in use has a major deleterious effect on cognition in hypertensive patients, but some of the drugs more reliably benefit cognitive function in the hypertensive patient. As a class, the angiotensin-converting enzyme inhibitors most consistently lead to cognitive improvement in the overall hypertensive population, but beta 1-adrenergic receptor blockers and a subset of calcium channel blockers appear to have very similar effects. Animal studies and clinical studies in demented patients suggest that angiotensin-converting enzyme in the cerebral cortex plays a role in normal learning and memory, a finding that provides a theoretic foundation to the beneficial actions of this class of drugs on cognitive function in hypertensive individuals.