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Der Klinikarzt 2009; 38(5): 234-239
DOI: 10.1055/s-0029-1225546
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© Georg Thieme Verlag Stuttgart · New York

Hypertonie und ihre Behandlung in der Prävention der Alzheimerkrankheit – Auswirkung der Blutdruckwerte auf kognitive Funktionen

Hypertension and its therapy for the prevention of Alzheimer's disease – Association between hypertension and cognitive functionStefan Schwarz1 , Lutz Frölich1
  • 1Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim
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Publication History

Publication Date:
03 June 2009 (online)

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Arterielle Hypertonie im mittleren Lebensalter ist mit der Entwicklung einer Demenz im späteren Lebensalter assoziiert. Dies bezieht sich nicht nur auf vaskuläre Demenz, sondern auch auf die Alzheimerkrankheit. Bei alten Menschen sowie bei Patienten mit Alzheimer–Demenz ist diese Assoziation nicht eindeutig; im Gegenteil, es gibt Hinweise, dass sich bei diesen Personen zu niedrige Blutdruckwerte ungünstig auf die kognitiven Funktionen auswirken. Mehrere randomisierte Studien haben mögliche günstige Auswirkungen einer antihypertensiven Therapie auf die Entwicklung einer Demenz untersucht. Die Ergebnisse sind inkonklusiv, sodass bisher nicht sicher belegt ist, dass eine antihypertenisve Behandlung das Demenzrisiko senkt. Zahlreiche methodische Limitationen werden zur Erklärung der negativen Studienergebnisse herangezogen. Ebenso ist es nicht gesichert, dass bei Patienten mit manifester Demenz eine Blutdrucksenkung eine Verschlechterung der kognitiven Leistungen verursachen kann. Bei diesen Patienten, vor allem wenn eine vaskuläre Komponente vorliegt, sollte die Blutdrucksenkung behutsam unter Beobachtung der kognitiven Leistungsfähigkeit erfolgen.

Arterial hypertension has been associated with dementia in later life. This association has not only been described for vascular dementia, but also for Alzheimer's disease. In elderly people and in patients with Alzheimer's disease the association between hypertension and cognitive function is uncertain; on the contrary; in these persons, low blood pressure has been linked to poor cognitive function and a more rapid cognitive decline. Several randomized studies analysed the potential benefits of antihypertensive therapy on dementia risk. However, the results of these studies are inconclusive. Up to now, a protective effect of antihypertensive therapy on the incidence of dementia has not been firmly established. A variety of methodological limitations may explain these discouraging results. Several observational studies indicate that in patients with dementia, lowering blood pressure could cause or worsen cognitive decline. However, the results of the larger randomized studies did not confirm these findings. In particular in patients with cerebrovascular lesions, elevated blood pressure should be treated gradually under close observation of cognitive functions.

Key words

Alzheimer's disease - vascular dementia - arterial hypertension - antihypertensive therapy - risk factor

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Korrespondenz

Prof. Dr. Stefan Schwarz

Zentralinstitut für Seelische Gesundheit Universität Heidelberg

Quadrat J 5

68159 Mannheim

Phone: 0621/1703-3302/-3304

Fax: 0621/1703-3305

Email: st_schwarz@hotmail.com

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