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From INSERM U 360 (Drs. Tzourio and Alpérovitch, and C. Dufouil), Hôpital de la Salpêtrière, Paris; and INSERM U 258 (Dr. Ducimetière), Hôpital Paul-Brousse, Villejuif, France.
Address correspondence and reprint requests to Dr. C. Tzourio, INSERM U 360, Hôpital de la Salpêtrière, 75651 Paris cedex 13, France.
OBJECTIVE: To examine whether baseline high blood pressure and antihypertensive treatment predicts cognitive decline in elderly individuals.
METHODS: A longitudinal population-based study of elderly individuals (n = 1,373) in Nantes (western France) was undertaken. Individuals 59 to 71 years of age were selected from electoral rolls. High blood pressure at baseline was defined as systolic blood pressure 
160 mm Hg or diastolic blood pressure 95 mm Hg. Cognitive decline was defined as a drop of 4 points or more on the Mini-Mental State Examination between baseline and the 4-year assessment.
RESULTS: There is an association between high blood pressure at baseline and cognitive decline at the 4-year assessment (odds ratio, 2.8; 95% CI, 1.6 to 5.0). In participants with high blood pressure, the risk of cognitive decline was 4.3 (95% CI, 2.1 to 8.8) in those without antihypertensive therapy and 1.9 (95% CI, 0.8 to 4.4) in those being treated. In participants with high blood pressure both at baseline and at the 2-year assessment, the risk for untreated participants was 6.0 (95% CI, 2.4 to 15.0) compared with 1.3 (95% CI, 0.3 to 4.9) in treated participants.
CONCLUSIONS: High blood pressure was associated with cognitive decline. In individuals with high blood pressure, cognitive decline occurred in a relatively short time period and the risk was highest in untreated hypertensive patients.
Key words: Cognitive decline—High blood pressure—Antihypertensives—Longitudinal studies.
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