Neurovascular and Cognitive Dysfunction in Hypertension Epidemiology, Pathobiology, and Treatment
Neurovascular and Cognitive Dysfunction in Hypertension Epidemiology, Pathobiology, and Treatment
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DOI：
10.1161/circresaha.118.313260
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发表时间：
2019-03-29
影响因子：
20.1
通讯作者：
Gottesman, Rebecca F.
中科院分区：
文献类型：
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作者：
Iadecola, Costantino;Gottesman, Rebecca F.
高血压已经成为与年龄相关的认知障碍的主要原因。长期以来，高血压被认为与血管因素引起的痴呆症有关，最近又被认为与老年痴呆症有关，老年痴呆症是老年人痴呆的主要原因。因此，虽然中年高血压是老年痴呆症的一个危险因素，但高血压也可能促进阿尔茨海默病的神经退行性病变。这些有害影响的机制基础仍有待确定。众所周知，高血压会改变脑血管的结构和功能，但这些脑血管效应如何导致认知障碍并促进阿尔茨海默病病理学尚不清楚。此外，关键问题还涉及高血压治疗是否能预防认知障碍、治疗的血压阈值和使用的降压药。神经血管生物学、流行病学、脑成像和生物标志物开发的最新进展已经开始为这些关键问题提供新的见解。在这次审查中，我们将审查迄今为止所取得的进展，并在对证据进行批判性评估后，我们将突出仍然悬而未决的问题，并寻求为未来的研究提供一条前进的道路。
Hypertension has emerged as a leading cause of age-related cognitive impairment. Long known to be associated with dementia caused by vascular factors, hypertension has more recently been linked also to Alzheimer disease-the major cause of dementia in older people. Thus, although midlife hypertension is a risk factor for late-life dementia, hypertension may also promote the neurodegenerative pathology underlying Alzheimer disease. The mechanistic bases of these harmful effects remain to be established. Hypertension is well known to alter in the structure and function of cerebral blood vessels, but how these cerebrovascular effects lead to cognitive impairment and promote Alzheimer disease pathology is not well understood. Furthermore, critical questions also concern whether treatment of hypertension prevents cognitive impairment, the blood pressure threshold for treatment, and the antihypertensive agents to be used. Recent advances in neurovascular biology, epidemiology, brain imaging, and biomarker development have started to provide new insights into these critical issues. In this review, we will examine the progress made to date, and, after a critical evaluation of the evidence, we will highlight questions still outstanding and seek to provide a path forward for future studies.