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Medicineworld.org: Hypertension Linked to Dementia

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Hypertension Linked to Dementia




Older women with high blood pressure are at increased risk for developing brain lesions that cause dementia during the later part of life, as per data from the Women's Health Initiative Memory Study (WHIMS). The findings were reported in the December 2009 online issue of the Journal of Clinical Hypertension.

The research was conducted as part of the Women' Health Initiative (WHI), the largest multi-site longitudinal study looking at health risks among postmenopausal women. WHIMS, which involves a subgroup of the women enrolled in WHI, looks at the influence of hormone treatment on thinking and memory. All the women in WHIMS were 65 or older.



Hypertension Linked to Dementia

Upon enrolling in the trial and annually during their participation in it, the women had their blood pressure measured and underwent tests to measure their cognitive ability. Some of the WHIMS participants - 1,403 of them - also underwent magnetic resonance imaging (MRI) at 14 U.S. academic centers in 2005 and 2006. All of these women were free of dementia when they enrolled. Examination of the data on these 1,403 women was led by Lewis H. Kuller, M.D., Dr.P.H., of the University of Pittsburgh, in conjunction with scientists at other WHI centers, including Dr. Sylvia Wassertheil-Smoller, Ph.D., professor of epidemiology and population health and the Dorothy and William Manealoff Foundation & Molly Rosen Chair in Social Medicine at Albert Einstein College of Medicine. Dr. Wassertheil-Smoller is also the principal investigator of Einstein's WHI and WHIMS studies.

The MRI studies revealed that women who, on entry to the WHIMS trial, had elevated blood pressure (defined as systolic blood pressure =140 mmHg, or diastolic blood pressure = 90 mmHg, or being on antihypertensive drug treatment), had significantly higher amounts of white matter lesions (WMLs) when they underwent MRIs eight years later. Normal blood pressure is defined as a systolic blood pressure of 120 or less and a diastolic pressure of 80 or less.

"Based on our findings, we would encourage women to maintain their blood pressure at normal levels, which may reduce their risk of dementia," says co-author of study Dr. Wassertheil-Smoller.

The small blood vessels in the brain are particularly susceptible to damage from even moderately elevated blood pressure - resulting in damage to the white matter served by those vessels. The brain's white matter is composed of whitish myelin-coated axons (nerve cell appendages) that allow nerve cells to communicate with each other and help the regions of the brain work together. Several studies have observed that damage to white matter, as indicated by the presence of WMLs, seems to be an independent risk factor for dementia.

The current study reinforces earlier research showing that high blood pressure plays a role in causing dementia, suggesting that preventing high blood pressure from developing - through weight loss, exercise or other changes in lifestyle - would be beneficial.

"However, we don't know whether high blood pressure therapy will prevent WMLs from developing, or how much blood pressure should be lowered so that these brain lesions won't occur," says Dr. Wassertheil-Smoller. "We do have suggestive evidence that the progression of WMLs can be slowed by anti-hypertensive treatment".

"Nonetheless," she adds, "it would be prudent for women to keep their blood pressure low, and the earlier in life they start doing so, the better. At present, keeping blood pressure at normal levels is probably the most effective way we know of to prevent dementia from occurring." As per baseline data on more than 98,705 women ages 50-79 who enrolled in the WHI study, 37.8% had hypertension, which is defined as systolic blood pressure =140 mm Hg and/or diastolic blood pressure =90 mm Hg or being on medicine for high blood pressure; 64.3% of the hypertensive women were treated with drugs, and blood pressure was controlled in only 36.1% of the hypertensive women, with lower rates of control in the oldest group.

Dr. Wassertheil-Smoller notes that hypertension is also a major risk factor for stroke, "so it is certainly not good for the brain." She says that further clinical trials are needed to better establish whether anti-hypertensive treatment can prevent or slow WMLs, and, if so, to find the specific drug therapies that work best.


Posted by: Daniel    Source




Did you know?
Older women with high blood pressure are at increased risk for developing brain lesions that cause dementia during the later part of life, as per data from the Women's Health Initiative Memory Study (WHIMS). The findings were reported in the December 2009 online issue of the Journal of Clinical Hypertension.

Medicineworld.org: Hypertension Linked to Dementia

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