Partially supporting Kennelly et al., Birns and Kalra[24] concluded that the majority of studies showed an association between raised blood pressure and a decline in cognitive function, but that the evidence for improved or maintained cognition after

pharmacological lowering of blood pressure was conflicting. The review by Fournier et al.[25] accepted that antihypertensive drugs prevented the onset of cognitive decline and dementia in patients with hypertension but concluded that calcium-channel blockers (CCBs) and AIIA antihypertensives were more effective than ACEIs and diuretic antihypertensives, which only affected cognition in those patients with a history of stroke. They did, however, report that a small study in Japanese patients suggested that those ACEIs able to penetrate AZD2014 research buy the blood–brain barrier may prevent cognitive decline. Shah et al.[26] reviewed papers up until mid-2009 and similarly concluded that ACEIs, but also

diuretics, were able significantly to reduce the progression to dementia. There have been no randomized, controlled, clinical trials but 18 cohort studies BIBW2992 of hypertension, cognition and antihypertensive therapies published in 2009 and 2010 add to the debate (see Table 1[27–44]). A small study in 782 very elderly Chinese individuals reported that there was no association between blood pressure and cognition,[27] but a much larger study in nearly 20 000 individuals determined that increased blood pressure was associated with impaired cognition;[28] this result was replicated in a study in nearly 2000 individuals over 70 years of age in rural China.[29] Similarly, a study in 73 stroke-free and dementia-free patients showed that increased blood pressure was associated

with decreased Niclosamide cognitive function.[30] There was some suggestion, however, that the association of blood pressure with cognition was dependent on age. Euser et al.[31] studied the association of blood pressure and cognition in over 3000 young and old patients. In the younger individuals there was no association between blood pressure and cognition, but in the 65–74-year age group increased blood pressure was associated with decreased cognition. Paradoxically, in those patients over 75 years, increased blood pressure was associated with increased cognitive ability,[31] highlighting the association of hypotension with cognitive impairment. Independently, a psychometric study in 525 subjects determined that blood pressure was able to account for 11% of the variance in scores on tests of cognition.[32] Several studies considered the association of blood pressure and diagnoses of Alzheimer’s disease or dementia rather than results of tests of cognition. Cherbuin et al.