Hypertension and the risk of dementia in the elderly
Article Abstract:
Vascular dementia is second only to Alzheimer's disease (AD) as a cause of mental deterioration among the elderly. Six forms of vascular dementia have been described, but often the term multi-infarct dementia (MID), the most common type, is used for all of them. The symptoms for the different forms of vascular dementia are listed in a table accompanying this article. The severity of vascular dementia is determined by the amount and location of tissue damage. One person in 20 over age 65, and perhaps as many as one in five over age 80 suffer from severe dementia. AD causes slightly more than half of these cases, and vascular disease causes another 10 to 20 percent or more. Twenty percent of the elderly mentally impaired have both disorders. Diagnosis consists of recognizing the dementia, and then determining the cause, using mental status examinations and computerized tomography. Although there may be periods of stability or even improvement, vascular dementia is progressive and has a lower survival rate than AD. There is no recognized treatment. Prevention consists of avoiding strokes, particularly by lowering high blood pressure. None of the previous therapeutic trials evaluated the ability to prevent vascular dementia. The SYST-EUR study is a cooperative trial to determine the effect of isolated systolic hypertension treatment with a calcium antagonist (nitrendipine), an angiotensin-converting enzyme inhibitor, or ACE (enalapril), and a diuretic (hydrochlorothiazide) on illness and death among patients over 60 years old. The incidence of vascular dementia will be noted, to determine whether the incidence of vascular dementia is related to antihypertensive treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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The relationship of sodium balance and concomitant diuretic therapy to blood pressure response with calcium channel entry blockers
Article Abstract:
In essential hypertension, or high blood pressure with no detectable direct cause, drug treatment is often used to reduce the level of blood pressure. Administration of a single drug causes a satisfactory normalization of blood pressure in between 40 and 60 percent of hypertensive patients. The addition of a second antihypertensive drug usually brings blood pressure under control in about 85 percent of patients. Diuretics (drugs that increase in excretion of urine and reduce blood volume) often cause further decreases in blood pressure when added to a nondiuretic regimen; this does not appear to be the case when diuretics are added to an antihypertensive regimen that includes calcium antagonists (drugs that reduce blood pressure in part by blocking the entry of calcium into cells, reducing constriction of the muscle fibers making up the walls of the blood vessels). This may be so because calcium antagonists reduce blood pressure not only through blocking calcium entry, but also by increasing fluid and sodium excretion in the urine, which has a recognized antihypertensive effect. This would also explain the failure of reducing dietary sodium intake to further reduce blood pressure in calcium antagonist-treated patients. Because reduction of fluid volume or sodium concentration caused by calcium antagonists does not trigger the hormonal response usually accompanying sodium or volume depletion, the adverse metabolic effects typically associated with activation of those systems do not occur. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
User Contributions:
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