Hot Topics in Neurology and Psychiatry - Editors-in-chief: Rita Moretti, Paola Torre

Massimo Volpe, Angelo Scuteri

Correspondence to:
Massimo Volpe - MD, FAHA, FESC
Professor of Cardiology
Chair and Division of Cardiology
II Faculty of Medicine
University “La Sapienza” of Rome
Sant’Andrea Hospital
Rome, Italy
E-mail: massimo.volpe@uniroma1.it

DOI: 10.4147/HTN-080117

Abstract

In older people, there is an increased prevalence of hypertension, which is the most common risk factor for both stroke and microvascular brain damage. Arterial aging, mostly stiffening of large arteries, is suggested to be the prominent link between hypertension and cardiovascular disease, including cognitive decline and dementia. Stiffer arteries are the cause for increased blood pressure variability, and in older people suffering from hypertension, cerebral autoregulation is altered to such a point that constant blood flow cannot be maintained over a wide blood pressure range. Recent data indicate that high pulse pressure, a clinical indicator of arterial stiffness, is associated with significantly increased risk of developing atrial fibrillation (a well known risk factor for microvascular brain damage), prevalence and severity of cerebral white matter lesions, and an increased risk of dementia. There is need for more studies in order to clarify the optimal blood pressure level, possibly focusing on the search for antihypertensive therapy that would prevent microvascular brain lesions and include neuroprotective effects at the same time.

Summary

• AGING, HYPERTENSION, AND BRAIN DAMAGE: CLINICAL OBSERVATIONS
• FROM PATHOPHYSIOLOGY TO THE MANAGEMENT OF THE OLDER HYPERTENSIVE SUBJECT AT RISK OF COGNITIVE DECLINE
• THERAPEUTIC APPROACH
• Need for treating hypertension
• Risk of undertreatment
• The risk of cognitive decline associated with hypertension is reversible in older subjects
• Treatment goal: systolic pressure or diastolic pressure control? Not widening pulse pressure
• CONCLUSION
• REFERENCES