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Correspondence
July 2008

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

Arch Neurol. 2008;65(7):992-996. doi:10.1001/archneur.65.7.nlt0708

In reply

We appreciate the comments by Dr Panza and colleagues regarding our article demonstrating a relation between hypertension and an increased risk of all-cause MCI and NAMCI but not AMCI.1 Several studies have shown associations of dementia and cognitive decline with several vascular risk factors, including hypertension. Hypertension is a risk factor for cerebrovascular disease and vascular dementia, but it is unclear what role it has in AD, which is characterized by the deposition of β-amyloid.2 It is possible that hypertension causes cognitive impairment through cerebrovascular disease or white matter hyperintensities. Alternatively, hypertension may contribute to a blood-brain barrier dysfunction, which has been suggested to be involved in the etiology of dementia, or through shared risk factors, such as the formation of oxygen free radicals.

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