Проблема деменции имеет очень важное медицинское, социальное и экономическое значение ввиду старения популяции. В представленном обзоре отражено место артериальной гипертонии как фактора риска деменции и методы выявления деменции в реальной клинической практике. Анализируется неоднозначная взаимосвязь уровня артериального давления с развитием и прогрессированием различных типов деменции. Приведены данные об эффективности современной антигипертензивной терапии для профилактики деменции с фокусом на потенциале антагониста кальция нитрендипина, показавшего свой церебропротективный потенциал в ряде экспериментальных исследований и крупномасштабном рандомизированном плацебо-контролируемом исследовании Syst-Eur.
The problem of dementia has a very important medical, social and economic importance in terms of the ageing of population. This review deals with the place of arterial hypertension as a risk factor for dementia and detection methods for dementia in the real clinical practice. The authors have analyzed the questionable association between blood pressure level and the development and progression of various types of dementia. The article showed the information about the efficacy of modern antihypertensive therapy for prevention of dementia with a focus on the potential of nitrendipine (calcium antagonist), which had showed the cerebroprotective potential in a number of investigational studies and large scale randomized placebo-controlled trial Syst-Eur.
1. Wimo A, Winblad B, Aguero-Torres H, von Strauss E. The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord 2003; 17 (2): 63–7.
2. Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry 1998; 6 (2 Suppl. 1): S3–18.
3. Ruitenberg A, Ott A, van Swieten JC et al. Incidence of dementia: does gender make a difference? Neurobiol Aging 2001; 22 (4): 575–80.
4. Roman GC. Vascular dementia revisited: diagnosis, pathogenesis, treatment, and prevention. Med Clin North Am 2002; 86 (3): 477–99.
5. Shehab A, Abdulle A. Cognitive and autonomic dysfunction measures in normal controls, white coat and borderline hypertension. BMC Cardiovasc Disord 2011; 11: 3.
6. Mahoney JR, Verghese J, Goldin Y et al. Alerting, orienting, and executive attention in older adults. J Int Neuropsychol Soc 2010; 16 (5): 877–89.
7. Richmond R, Law J, Kay-Lambkin F. Higher blood pressure associated with higher cognition and functionality among centenarians in Australia. Am J Hypertens 2011; 24 (3): 299–303.
8. Szewieczek J, Dulawa J, Gminski J et al. Better cognitive and physical performance is associated with higher blood pressure in centenarians. J Nutr Health Aging 2011; 15 (8): 618–22.
9. Skoog I, Lernfelt B, Landahl S et al. 15year longitudinal study of blood pressure and dementia. Lancet 1996; 347 (9009): 1130.
10. Elias MF, Elias PK, Sullivan LM et al. Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study. Int J Obes Relat Metab Disord 2003; 27 (2): 260–8.
11. Goldstein FC, Levey AI, Steenland NK. High blood pressure and cognitive decline in mild cognitive impairment. J Am Geriatr Soc 2013; 61 (1): 67–73.
12. Launer LJ, Hughes T, Yu B et al. Lowering midlife levels of systolic blood pressure as a public health strategy to reduce late-life dementia: perspective from the Honolulu Heart Program/Honolulu Asia Aging Study. Hypertension 2010; 55 (6): 1352–9.
13. Reijmer YD, van den Berg E, Dekker JM et al. Development of vascular risk factors over 15 years in relation to cognition: the Hoorn Study. J Am Geriatr Soc 2012; 60 (8): 1426–33.
14. Hebert LE, Scherr PA, Bennett DA et al. Blood pressure and late-life cognitive function change: a biracial longitudinal population study. Neurology 2004; 62 (11): 2021–4.
15. Tervo S, Kivipelto M, Hanninen T et al. Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects. Dement Geriatr Cogn Disord 2004; 17 (3): 196–203.
16. Bohannon AD, Fillenbaum GG, Pieper CF et al. Relationship of race/ethnicity and blood pressure to change in cognitive function. J Am Geriatr Soc 2002; 50 (3): 424–9.
17. Xu W, Tan L, Wang H-F et al. Meta-analysis of modifiable risk factors for Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2015; 86 (12): 1299–306.
18. Hajjar I, Zhao P, Alsop D, Novak V. Hypertension and cerebral vasoreactivity: a continuous arterial spin labeling magnetic resonance imaging study. Hypertension 2010; 56 (5): 859–64.
19. Qiu C, Winblad B, Viitanen M, Fratiglioni L. Pulse pressure and risk of Alzheimer disease in persons aged 75 years and older: a community-based, longitudinal study. Stroke 2003; 34 (3): 594–9.
20. Nation DA, Delano-Wood L, Bangen KJ et al. Antemortem pulse pressure elevation predicts cerebrovascular disease in autopsy-confirmed Alzheimer’s disease. J Alzheimers Dis 2012; 30 (3): 595–603.
21. Rabkin SW, Jarvie G. Comparison of vascular stiffness in vascular dementia, Alzheimer dementia and cognitive impairment. Blood Press 2011; 20 (5): 274–83.
22. Diz DI, Lewis K. Dahl memorial lecture: the renin-angiotensin system and aging. Hypertension 2008; 52 (1): 37–43.
23. Gustafson DR, Melchior L, Eriksson E et al. The ACE insertion deletion polymorphism relates to dementia by metabolic phenotype, APOEepsilon4, and age of dementia onset. Neurobiol Aging 2010; 31 (6): 910–6.
24. Jennings JR, Heim AF. From brain to beh * avior: hypertension’s modulation of cognition and affect. Int J Hypertens 2012; 2012: 701385.
25. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (9): 2672–713.
26. Bosch J, Lonn E, Yusuf S; HOPE-3 Investigators. The effect of blood pressure and cholesterol lowering on cognition. Program and abstracts of the American Heart Association 2016 Scientific Sessions; November 13, 2016; New Orleans, Louisiana. Abstract LBCT-01.
27. Staessen JA, Thijs L, Richart T et al. Placebo-controlled trials of blood pressure-lowering therapies for primary prevention of dementia. Hypertension 2011; 57: e6–7.
28. Chang-Quan H, Hui W, Chao-Min W et al. The association of antihypertensive medication use with risk of cognitive decline and dementia: a meta-analysis of longitudinal studies. Int J Clin Pract 2011; 65 (12): 1295–305.
29. Petrella RJ, Shlyakhto E, Konradi AO et al. Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of the Observational Study on Cognitive Function and SBP Reduction (OSCAR) study. J Clin Hypertens (Greenwich) 2012; 14 (2): 78–84.
30. Kume K, Hanyu H, Sakurai H et al. Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer’s disease. Geriatr Gerontol Int 2012; 12 (2): 207–14.
31. Chiu WC, Ho WC, Lin MH et al. Angiotensin receptor blockers reduce the risk of dementia. J Hypertens 2014, 32: 938–47.
32. Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2012; 75 (1): 79–92.
33. Pase MP, Beiser A, Himali JJ et al. Aortic Stiffness and the Risk of Incident Mild Cognitive Impairment and Dementia. Stroke 2016; 47: 2256–61.
34. Mattace-Raso F, van der Cammen TJM, Hofman A et al. Arterial Stiffness and Risk of Coronary Heart Disease and Stroke. The Rotterdam Study. Circulation 2006; 113: 657–63.
35. Toescu EC, Xiong J. Metabolic substrates of neuronal aging. Ann N Y Acad Sci 2004; 1019: 19–23.
36. Bachmeier C, Beaulieu-Abdelahad D, Mullan M, Paris D. Selective dihydropyiridine compounds facilitate the clearance of beta-amyloid across the blood-brain barrier. Eur J Pharmacol.2011; 659: 124–9.
37. Paris D, Bachmeier C, Patel N et al. Selective antihypertensive dihydropyridines lower abeta accumulation by targeting both the production and the clearance of abeta across the blood-brain barrier. Mol Med 2011; 17: 149–62.
38. Corbett A, Pickett J, Burns A et al. Drug repositioning for Alzheimer’s disease. Nature Reviews Drug Discovery 2012; 11: 833–46.
39. Watfa G, Rossignol P, Kearney-Schwartz A et al. Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints. J Hypertens 2010; 28 (12): 2485–93.
40. Trompet S et al. Use of calcium antagonists and cognitive decline in old age. The Leiden 85-plus study. Neurobiol Aging 2008; 29 (2): 306–8.
41. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
42. Thijs L, Staessen JA, Beleva S et al. How well can blood pressure be controlled? Progress report on the Systolic Hypertension in Europe Follow-Up Study (Syst-Eur 2). Curr Control Trials Cardiovasc Med 2001; 2: 298–306.
43. Tuomilehto J et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
44. Liu L, Wang JG, Gong L et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertension 1998; 16: 1823–9.
45. Forette F, Seux ML, Staessen JA et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352 (9137): 1347–51.
________________________________________________
1. Wimo A, Winblad B, Aguero-Torres H, von Strauss E. The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord 2003; 17 (2): 63–7.
2. Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry 1998; 6 (2 Suppl. 1): S3–18.
3. Ruitenberg A, Ott A, van Swieten JC et al. Incidence of dementia: does gender make a difference? Neurobiol Aging 2001; 22 (4): 575–80.
4. Roman GC. Vascular dementia revisited: diagnosis, pathogenesis, treatment, and prevention. Med Clin North Am 2002; 86 (3): 477–99.
5. Shehab A, Abdulle A. Cognitive and autonomic dysfunction measures in normal controls, white coat and borderline hypertension. BMC Cardiovasc Disord 2011; 11: 3.
6. Mahoney JR, Verghese J, Goldin Y et al. Alerting, orienting, and executive attention in older adults. J Int Neuropsychol Soc 2010; 16 (5): 877–89.
7. Richmond R, Law J, Kay-Lambkin F. Higher blood pressure associated with higher cognition and functionality among centenarians in Australia. Am J Hypertens 2011; 24 (3): 299–303.
8. Szewieczek J, Dulawa J, Gminski J et al. Better cognitive and physical performance is associated with higher blood pressure in centenarians. J Nutr Health Aging 2011; 15 (8): 618–22.
9. Skoog I, Lernfelt B, Landahl S et al. 15year longitudinal study of blood pressure and dementia. Lancet 1996; 347 (9009): 1130.
10. Elias MF, Elias PK, Sullivan LM et al. Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study. Int J Obes Relat Metab Disord 2003; 27 (2): 260–8.
11. Goldstein FC, Levey AI, Steenland NK. High blood pressure and cognitive decline in mild cognitive impairment. J Am Geriatr Soc 2013; 61 (1): 67–73.
12. Launer LJ, Hughes T, Yu B et al. Lowering midlife levels of systolic blood pressure as a public health strategy to reduce late-life dementia: perspective from the Honolulu Heart Program/Honolulu Asia Aging Study. Hypertension 2010; 55 (6): 1352–9.
13. Reijmer YD, van den Berg E, Dekker JM et al. Development of vascular risk factors over 15 years in relation to cognition: the Hoorn Study. J Am Geriatr Soc 2012; 60 (8): 1426–33.
14. Hebert LE, Scherr PA, Bennett DA et al. Blood pressure and late-life cognitive function change: a biracial longitudinal population study. Neurology 2004; 62 (11): 2021–4.
15. Tervo S, Kivipelto M, Hanninen T et al. Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects. Dement Geriatr Cogn Disord 2004; 17 (3): 196–203.
16. Bohannon AD, Fillenbaum GG, Pieper CF et al. Relationship of race/ethnicity and blood pressure to change in cognitive function. J Am Geriatr Soc 2002; 50 (3): 424–9.
17. Xu W, Tan L, Wang H-F et al. Meta-analysis of modifiable risk factors for Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2015; 86 (12): 1299–306.
18. Hajjar I, Zhao P, Alsop D, Novak V. Hypertension and cerebral vasoreactivity: a continuous arterial spin labeling magnetic resonance imaging study. Hypertension 2010; 56 (5): 859–64.
19. Qiu C, Winblad B, Viitanen M, Fratiglioni L. Pulse pressure and risk of Alzheimer disease in persons aged 75 years and older: a community-based, longitudinal study. Stroke 2003; 34 (3): 594–9.
20. Nation DA, Delano-Wood L, Bangen KJ et al. Antemortem pulse pressure elevation predicts cerebrovascular disease in autopsy-confirmed Alzheimer’s disease. J Alzheimers Dis 2012; 30 (3): 595–603.
21. Rabkin SW, Jarvie G. Comparison of vascular stiffness in vascular dementia, Alzheimer dementia and cognitive impairment. Blood Press 2011; 20 (5): 274–83.
22. Diz DI, Lewis K. Dahl memorial lecture: the renin-angiotensin system and aging. Hypertension 2008; 52 (1): 37–43.
23. Gustafson DR, Melchior L, Eriksson E et al. The ACE insertion deletion polymorphism relates to dementia by metabolic phenotype, APOEepsilon4, and age of dementia onset. Neurobiol Aging 2010; 31 (6): 910–6.
24. Jennings JR, Heim AF. From brain to beh * avior: hypertension’s modulation of cognition and affect. Int J Hypertens 2012; 2012: 701385.
25. Gorelick PB, Scuteri A, Black SE et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (9): 2672–713.
26. Bosch J, Lonn E, Yusuf S; HOPE-3 Investigators. The effect of blood pressure and cholesterol lowering on cognition. Program and abstracts of the American Heart Association 2016 Scientific Sessions; November 13, 2016; New Orleans, Louisiana. Abstract LBCT-01.
27. Staessen JA, Thijs L, Richart T et al. Placebo-controlled trials of blood pressure-lowering therapies for primary prevention of dementia. Hypertension 2011; 57: e6–7.
28. Chang-Quan H, Hui W, Chao-Min W et al. The association of antihypertensive medication use with risk of cognitive decline and dementia: a meta-analysis of longitudinal studies. Int J Clin Pract 2011; 65 (12): 1295–305.
29. Petrella RJ, Shlyakhto E, Konradi AO et al. Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of the Observational Study on Cognitive Function and SBP Reduction (OSCAR) study. J Clin Hypertens (Greenwich) 2012; 14 (2): 78–84.
30. Kume K, Hanyu H, Sakurai H et al. Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer’s disease. Geriatr Gerontol Int 2012; 12 (2): 207–14.
31. Chiu WC, Ho WC, Lin MH et al. Angiotensin receptor blockers reduce the risk of dementia. J Hypertens 2014, 32: 938–47.
32. Manisty CH, Hughes AD. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2012; 75 (1): 79–92.
33. Pase MP, Beiser A, Himali JJ et al. Aortic Stiffness and the Risk of Incident Mild Cognitive Impairment and Dementia. Stroke 2016; 47: 2256–61.
34. Mattace-Raso F, van der Cammen TJM, Hofman A et al. Arterial Stiffness and Risk of Coronary Heart Disease and Stroke. The Rotterdam Study. Circulation 2006; 113: 657–63.
35. Toescu EC, Xiong J. Metabolic substrates of neuronal aging. Ann N Y Acad Sci 2004; 1019: 19–23.
36. Bachmeier C, Beaulieu-Abdelahad D, Mullan M, Paris D. Selective dihydropyiridine compounds facilitate the clearance of beta-amyloid across the blood-brain barrier. Eur J Pharmacol.2011; 659: 124–9.
37. Paris D, Bachmeier C, Patel N et al. Selective antihypertensive dihydropyridines lower abeta accumulation by targeting both the production and the clearance of abeta across the blood-brain barrier. Mol Med 2011; 17: 149–62.
38. Corbett A, Pickett J, Burns A et al. Drug repositioning for Alzheimer’s disease. Nature Reviews Drug Discovery 2012; 11: 833–46.
39. Watfa G, Rossignol P, Kearney-Schwartz A et al. Use of calcium channel blockers is associated with better cognitive performance in older hypertensive patients with subjective memory complaints. J Hypertens 2010; 28 (12): 2485–93.
40. Trompet S et al. Use of calcium antagonists and cognitive decline in old age. The Leiden 85-plus study. Neurobiol Aging 2008; 29 (2): 306–8.
41. Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment or older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64.
42. Thijs L, Staessen JA, Beleva S et al. How well can blood pressure be controlled? Progress report on the Systolic Hypertension in Europe Follow-Up Study (Syst-Eur 2). Curr Control Trials Cardiovasc Med 2001; 2: 298–306.
43. Tuomilehto J et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. Systolic Hypertension in Europe Trial Investigators. N Engl J Med 1999; 340: 677–84.
44. Liu L, Wang JG, Gong L et al. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertension 1998; 16: 1823–9.
45. Forette F, Seux ML, Staessen JA et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352 (9137): 1347–51.
Авторы
Ю.В.Котовская*1,2, В.С.Остапенко2, О.Н.Ткачева2
1 ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, Москва, ул. Миклухо-Маклая, д. 6;
2 «Российский геронтологический научно-клинический центр» ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова». 129226, Россия, Москва, ул. Леонова, д. 16а *kotovskaya@bk.ru
1 People’s Friendship University of Russia. 117198, Russian Federation, Moscow, ul. Miklukho-Maklaya, d. 6;
2 N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 129226, Russian Federation, Moscow, ul. Leonova, d. 16a *kotovskaya@bk.ru