REVIEW   

Minerva Cardiology and Angiology 2022 June;70(3):285-97

DOI: 10.23736/S2724-5683.20.05452-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Impact of arterial hypertension and its management strategies on cognitive function and dementia: a comprehensive umbrella review

Barbara ANTONAZZO ¹, Giuseppe MARANO ², Enrico ROMAGNOLI ³, Stefano RONZONI ¹, Giacomo FRATI ^{4, 5}, Gabriele SANI ², Luigi JANIRI ², Marianna MAZZA ² ✉

¹ Division of Geriatrics, Israelite Hospital, Rome, Italy; ² Department of Geriatrics, Institute of Psychiatry and Psychology, Neuroscience and Orthopedics, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy; ³ Department of Cardiovascular and Thoracic Sciences, Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Rome, Italy; ⁴ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy; ⁵ IRCCS NEUROMED, Pozzilli, Isernia, Italy

INTRODUCTION: Cognitive decline and dementia recognize multiple risk factors and pathophysiological mechanisms, often involved simultaneously with complex interactions. Several studies have shown that both arterial hypertension and hypotension are associated with a greater risk of cognitive decline and dementia, but clinical evidence on this point is conflicting. Our aim was to conduct an umbrella review on cognitive function, dementia, and blood pressure, with particular attention to epidemiological, prognostic and therapeutic aspects.
EVIDENCE ACQUISITION: We conducted a dedicated literature search on PubMed for systematic reviews and meta-analyses that focused on arterial pressure, hypertension, hypotension and similar conditions, and cognitive function, cognitive decline and dementia. The internal validity of systematic reviews and meta-analyses was formally analyzed using the OQAQ tool. The umbrella review was planned in accordance with current international recommendations and was described as specified by the PRISMA guidelines.
EVIDENCE SYNTHESIS: Seventeen systematic reviews (including 13 meta-analyses) were included, for a total of 675 clinical studies and over 1 million patients. Hypertension results to be associated with a lower risk of Alzheimer’s dementia, greater risk of vascular dementia and greater risk of cognitive decline. Orthostatic hypotension seems to be associated with greater risk of Alzheimer’s dementia, vascular dementia and dementia of Parkinson’s disease. Therapy with acetylcholinesterase inhibitors produces lower risk of cardiovascular events, greater risk of hypertension and greater risk of bradycardia, while the anti-hypertensive therapy leads to a lower risk of dementia of all types and lower risk of cognitive decline.
CONCLUSIONS: To date, the evidence on the relationship between blood pressure, cognitive decline and dementia provides somewhat heterogeneous data. Further studies are clearly needed, with explicit inclusion criteria as objective as possible, adequate follow-up and precise characterization of implemented cardiovascular and cognitive treatments.

KEY WORDS: Alzheimer disease; Arterial pressure; Cognitive dysfunction; Dementia