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Dementia is a major concern in the elderly hypertensive patient. Patients with hypertension have been shown to suffer cognitive dysfunction and dementia of all types more commonly than do normotensive subjects. The effects of antihypertensive therapy on dementia are not well documented. However, provocative findings from the Syst-Eur trial have shown that dihydropyridine calcium antagonists reduce dementia by as much as 55% (Figure 29) [69]. In some, but not all, studies, statins also showed a beneficial effect on dementia. Although this remains to be confirmed, it nevertheless makes calcium antagonists, possibly in combination with a statin, an attractive choice for the elderly patient. More recently ARBs and lipophilic ACE inhibitors have also been reported to reduce the risk of dementia.

Figure 29 Syst-Eur: Effect of calcium antagonist treatment on dementia. Syst-Eur, Systolic Hypertension in Europe. Reproduced from Forette etal. [69].

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