PubMed · 10950490
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
J S Markowitz, H Myrick, W Hiott. 1997. Clonidine dependence.. https://doi.org/10.1097/00004714-199704000-00025
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Explore the source record for details and available documents.
Hypertension is a risk factor for stroke and may also contribute to the development of vascular cognitive impairment (VCI) and vascular dementia (VaD). Cognitive complications of hypertension and the influence of anti-hypertensive treatment were underestimated until recently. In this paper, trials investigating the effect of anti-hypertensive treatment on cognitive function were evaluated. Analysis of these studies revealed that until approximately 1990-1995 investigations have assessed primarily if anti-hypertensive treatment impaired cognitive function. Only more recent studies have investigated positive effects on cognition of anti-hypertensive medication. Drugs more extensively evaluated were diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, sartanes and Ca(2+) channel blockers. Available studies have confirmed that elevated diastolic blood pressure or pulse pressure and isolated systolic hypertension play an important role in the development of cognitive impairment. Randomized placebo-controlled trials have provided evidence that reduction of hypertension safely and effectively decreases morbidity and mortality rates and cognitive complications of hypertension. Ca(2+) channel blockers and ACE inhibitors have been shown to be effective and probably better than diuretics and beta-blockers on cognitive domains of hypertension. More extensive investigations could contribute to establishing optimal choice and drug dosage for the treatment of cognitive complications of hypertension.
SUMMARY: Prevention is equivalent to causal treatment of cardiovascular disease. Nowadays, guidelines are elaborated on the basis of large-scale long-term intervention studies and structured meta-analyses. This review attempts a synopsis of guidelines of the American and German Heart Associations. For secondary prevention, smoking cessation, blood pressure treatment, dietary lipid management, aerobic activity, correct body weight, Mediterranean diet, treatment of diabetes to a HbA1c of 7%, ingestion of marine w-3 fatty acids (1 g / day), platelet inhibitors, lipid-lowering agents (statins), beta-blockers and ACE-inhibitors are established. In primary prevention pharmaceutical agents are not incorporated, but all non-pharmacological approaches are being recommended. The guidelines mentioned are based on unequivocal evidence, risk-benefit and cost-benefit ratios are good, nevertheless implementation remains a serious problem. Primary and secondary prevention are already giving way to risk-adapted prevention, based on an individual assessment of a person's cardiovascular risk.