2009 issue 2

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Volume 18, issue 2

Review

Controversies on bloodpressure control and the use of drugs acting via the cerebral renin-angiotensin- aldosterone system in Alzheimer's disease

Maciej Banasiak1,2, Tadeusz Pietras1, Ilona Kurnatowska2, Łukasz Wieteska3, Michał Nowicki2
1. Klinika Pneumonologii i Alergologii Instytutu Medycyny Wewnętrznej Uniwersytetu Medycznego w Łodzi
2. Klinika Nefrologii, Hipertensjologii i Transplantologii Nerek Uniwersytetu Medycznego w Łodzi
3. Zakład Psychologii Lekarskiej, Uniwersytet Medyczny w Łodzi
Postępy Psychiatrii i Neurologii 2009; 18 (2): 189-194
Keywords: Alzheimer's disease, vascular dementia, arterial hypertension, renin-angiotensin-aldosterone system, angiotensin-converting enzyme inhibitors, angiotensin II-receptor antagonists

Abstract

Objectives. The aim of this study is to review a potential role of antihypertensive drugs acting via the renin-angiotensin-aldosterone system (RAA) in theprevention and treatment of Alzheimer 's disease (AD).
Views. AD and vascular dementia (VD) are the most common causes of dementia. Recent research suggests a possible relationship between vascular and neurodegenerative diseases. Therefore, long-term arterial hypertension may contribute not only to vascular dementia, but also to the development of AD. Numerous epidemiological studies have reported that high mid-life blood pressure may increase the risk of developing AD in later life. A ąuestion arises whether the use of antihypertensive drugs could reduce the incidence of dementia and improve cognitive functions in AD patients. A potential role of antihypertensive drugs acting via the renin-angiotensin-aldosterone (RAA) system in theprevention of neurodegenerative disorders has been widely studied in recentyears. Earlier research findings indicate that the brain has its own independent RAA system that mediates some cognitive functions, such as memory and learning. It is also well known that angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists (ARA) reduce cardiovascular morbidity and mortality rates, irrespective of their blood pressure-lowering effect.
Conclusions. Although hypertension and cerebrovascular damage are significant factors in cognitive impairment and AD progression, the RAA involvement the pathophysiology ofAD and the potential role of drugs acting via the RAA system in the prevention and treatment of AD remain unclear. More controlled randomized prospective trials with well-defined endpoints are needed to determine the role of the RAA system and RAA-modifying antihypertensive treatment in the pathogenesis of AD.

Address for correspondence:
Dr Tadeusz Pietras
Klinika Pneumonologii i Alergologii Instytutu Medycyny Wewnętrznej Uniwersytetu Medycznego w Łodzi
91-123 Łódź, ul. Kopcińskiego 22
tel/fax (42)6782129
mail: cital200@wp.pl