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From the Departments of Psychiatry (L.B.H., J.S., M.S.B., H.T.G., V.H.), Geriatrics and Adult Development (G.T.L.), and Pathology (D.P.P.), Mount Sinai School of Medicine, New York; Jewish Home & Hospital (G.T.L.), New York; and JJ Peters Veterans Affairs Medical Center (H.T.G., V.H.), Bronx, NY.
Address correspondence and reprint requests to Dr. L. Hoffman, Psychiatry, Room 4F-20, Bronx VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468 lisa.b.hoffman{at}mssm.edu
Objective: To test the hypothesis that use of antihypertensive medication is associated with lower Alzheimer disease (AD) neuropathology.
Methods: This was a postmortem study of 291 brains limited to those with normal neuropathology or with uncomplicated AD neuropathology (i.e., without other dementia-associated neuropathology) in persons with or without hypertension (HTN) who were and were not treated with antihypertensive medications. Neuritic plaque (NP) and neurofibrillary tangle (NFT) densities, quantified in selected brain regions according to the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropathologic criteria, with additional cortical NP counts, yielded 24 neuropathologic regional measures or summaries. Medicated hypertension (HTN-med; n = 77), nonmedicated HTN (HTN-nomed; n = 42), and non-HTN (no-HTN; n = 172) groups were compared by analyses of variance.
Results: The HTN-med group had significantly less neuropathology than the no-HTN group. The no-HTN group averaged over 50% higher mean NP and NFT ratings, and double the mean NP count, of the HTN-med group. The HTN-nomed group had significantly more neuropathology than the HTN-med group, but not significantly less than the no-HTN group.
Conclusions: There was substantially less Alzheimer disease (AD) neuropathology in the medicated hypertension group than the nonhypertensive group, which may reflect a salutary effect of antihypertensive medication against AD-associated neuropathology.
Abbreviations: AD = Alzheimer disease; ANCOVA = analysis of covariance; ANOVA = analysis of variance; BB = β-blockers; BMI = body mass index; CCB = calcium channel blockers; CDR = Clinical Dementia Rating scale; CERAD = Consortium to Establish a Registry for Alzheimer’s Disease; DBP = diastolic blood pressure; EC = entorhinal cortex; HAAS = Honolulu Asia Aging Study; Hipp = hippocampus; HTN = hypertension; IPL = inferior parietal lobule; JHH = Jewish Home and Hospital; MFG = midfrontal gyrus; MSSM = Mount Sinai School of Medicine; NFT = neurofibrillary tangle; NH = nursing homes; NP = neuritic plaque; OC = occipital calcarine cortex; OFG = orbital frontal cortex; SBP = systolic blood pressure; STG = superior temporal gyrus.
See also page 1727
e-Pub ahead of print on February 18, 2009, at www.neurology.org.
Supported by NIA grants AG02219 and AG05138 and the Dextra Baldwin McGonagle and Joseph E. and Norma G. Saul Foundations.
Disclosure: The authors report no disclosures.
Received September 4, 2008. Accepted in final form January 5, 2009.
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