Lowering High Blood Pressure Can Reverse Some Dementia in the Elderly

From the WebMD Archives

May 18, 2001 (San Francisco) -- Three years ago Charles Vincent was overweight and had high blood pressure and high cholesterol. Worse, he was having trouble with his memory, having one too many "Alzheimer's moments."


Today, his blood pressure is a healthy 130/75, he is 20 pounds lighter, and his cholesterol is fine, even by the new stricter standards issued this week. Most of all, "I may not be as sharp as I was when I was 20, but I can do math faster than most 20-year-olds."


And just two days ago Vincent celebrated his 83rd birthday.


The difference between 1999 and this year can be explained by his blood pressure, says Edwin Jacobson, MD. Jacobson says that about 40% of dementia symptoms are caused not by Alzheimer's disease but by high blood pressure, a condition called vascular dementia.


Jacobson, a clinical professor of medicine at UCLA school of medicine, says that in a study of 66 patients with high blood pressure as well as mild dementia symptoms, controlling blood pressure meant that "progression of dementia was stopped and some effects of cognitive impairment were reversed." He presented his findings here this week at the 16th Scientific Meeting of the American Society of Hypertension.


Vincent, a retired business executive, tells WebMD that just a year ago his blood pressure was 160/90, not considered dangerously high "but high enough to affect my memory and ability to think clearly."


Jacobson says that a magnetic resonance scan of Vincent's brain confirmed that Vincent's brain had many small white scars, the type of damage that is associated with tiny, silent strokes. These silent strokes are "markers for vascular dementia," says Jacobson.


Jacobson says that many researchers have described the link between high blood pressure and dementia, but no one has attempted to reverse the dementia by controlling blood pressure.


In his study, 24 women and 42 men, aged 65 to 80, with high blood pressure and vascular dementia (as confirmed by magnetic resonance scans), were randomly chosen to take one of two different types of blood pressure medications. One drug, Vasotec, is what's called an ACE inhibitor, and the other drug, Plendil, is what's known as a calcium channel blocker. AstraZeneca, maker of Plendil, funded the study.



In addition to magnetic resonance scans, the patients were also assessed using memory and psychological tests. At study onset the scores on those tests were about "20% to 40% below normal. That means that these were people who were functioning but they were becoming limited. For example, they didn't wander off, but you wouldn't want these patients driving," says Jacobson.


Jacobson says that drug doses were increased until the patient reached the blood pressure goal of 130/90. Using this aggressive treatment approach "patients reached the goal by 12 weeks," says Jacobson. All patients had repeat memory and psychological tests at 12 weeks and again at six months.


At 12 weeks, both thinking and memory improved by 15% to 40%, and there were similar improvements in gait and other movements, says Jacobson. These improvements were still present at six months, he says.


The patients who had the most marked improvements on the memory and psychological tests -- about a third of the patients -- also had a type of brain scan called a PET scan. "PET scans measure brain activity and brain metabolism," says Jacobson. "The scans demonstrated a high level of brain activity in these patients."


Marvin Moser, MD, clinical professor of medicine at Yale University School of Medicine, tells WebMD that data from other studies suggest that controlling blood pressure in patients as old as 80 can improve many aspects of life, including cognitive function. He says that although high blood pressure is called "a silent killer, patients often tell us that they don't feel that well when they have high blood pressure. When the pressure comes down, the patient feels better."


Moser, who wasn't involved in the study, is an outspoken advocate for the elderly. He says that treating high blood pressure in an 80-year-old reduces the patient's risk of stroke and heart failure, as well as improving cognitive function.


Jacobson says that he is planning a much larger study to confirm the results of his small study.

WebMD Health News Reviewed by Tonja Wynn Hampton, MD on May 18, 2001
© 2001 WebMD, Inc. All rights reserved.