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July 2008

Antihypertensive Medications Influence the Rate of Conversion From Mild Cognitive Impairment to Alzheimer Disease

Arch Neurol. 2008;65(7):992-996. doi:10.1001/archneur.65.7.993

We read with interest the article by Reitz et al1 showing that a history of hypertension is related to a higher risk of mild cognitive impairment (MCI). To further discuss this topic, we analyzed 80 subjects consecutively recruited in our clinic who met the operational criteria for MCI at 2 years' follow-up. Subjects with conversion to Alzheimer disease over time were classified as having dementia; subjects who remained unchanged during follow-up were defined as stable. Sociodemographic and clinical characteristics are shown in the Table. When analyzed in a logistic regression model, older age (> 72 years) and Alzheimer Disease Assessment Scale, Cognitive Subscale basal score (> 9.5 points) were independently associated with the conversion to Alzheimer disease (older age: odds ratio, 9.9; 95% confidence interval, 2.2-43.9; P = .003; and Alzheimer Disease Assessment Scale, Cognitive Subscale basal score: odds ratio, 16.1; 95% confidence interval, 3.4-75.9; P < .001), whereas the use of antihypertensive medications was protective (odds ratio, 0.2; 95% confidence interval, 0.4-6.8; P = .02). No association has been found with APOEε4 genotype carriers and with loss of instrumental daily functions. The prescription of antihypertensive drugs exerts a protective function on the conversion of MCI to Alzheimer disease and supports previous findings,2,3 confirming that the use of these medications exerts an independent protective effect on cognitive deterioration as also suggested by Reitz and colleagues.

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