認知症を考慮した高血圧治療

Cognitive Function and Calcium. Hypertension treatment in consideration of dementia.

　高齢化社会の進行で増加している認知症は医学的にも社会的にも大きな問題となっているが，いまだに確立した根治療法はなく予防が重要である。中年期高血圧は認知症発症との関連性が示唆されており，中年期からの厳格な血圧コントロールは重要である。一方，高齢期高血圧と認知症発症との関連性は不明だが，降圧により認知機能低下が進展抑制された報告もあるため，早期からの慎重な降圧が望ましい。どの降圧薬が良いかは，降圧薬介入試験がまだないため，コンセンサスは得られていない。近年のネットワークメタ解析ではアンジオテンシン II 受容体拮抗薬（ARB）が有効とする報告がある。今後，認知症発症を一次エンドポイントとしたエビデンスの構築が待たれる。

　Dementia, which dramatically increased in recent years is one of the most important issues in the modern society. Solutions for prevention and management of dementia have not been established. Since hypertension status in middle-age period is known as a risk for the future development of dementia, antihypertensive treatment during such period is important. On the contrary, the influence on the dementia development of hypertension during old-age period has not been clarified yet. Since some reports showed that the antihypertensive treatment prevented the development of dementia, the proper antihypertensive treatment would be considered. It is still unknown that of which kind of antihypertensive drug is most effective for preventing dementia, since clinical trials have not been performed on such hypothesis to be solved. Recent report on the network meta-analysis showed that angiotensin receptor blockers were most effective. Future study should be done for develop the evidence for preventing dementia as a primary endpoint.