The effects of different antihypertensive agents on white matter lesions in long-lasting hypertension

Hypertension is not just the most avoidable cardiovascular risk factor, but also a risk factor for the prevalent dementia disease. The impact of antihypertensive medication in the prevention of dementia is still controversial. The aim of this study was to investigate the effect of different antihypertensive agents on white matter lesions that occur in the early stages of dementia and to compare their possible protective effects. Two hundred and twenty-four consecutive long-lasting hypertensive patients who had been taking the same antihypertensive agent for at least 1 year and who had undergone cranial magnetic resonance imaging for various indications were enrolled. The white matter lesions of the patients were evaluated by two independent and blind radiologists using the Fazekas score retrospectively. The patients were divided into 4 different groups according to their Fazekas score. There were no significant differences between the use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, alpha-blockers and diuretics in all Fazekas groups (p value 0.828, 0.753, 0.303, 0.099, 0.660 and 0.671, respectively). Advanced age and higher body mass index were associated with higher Fazekas scores (p value 0.008 and 0.027, respectively). The blood pressure, the number of antihypertensive agent used and biochemical parameters were not associated with Fazekas score. As a conclusion, the protective effect of antihypertensive agents on dementia disease and cognitive dysfunction is still a debate. Our results suggest that there is no significant difference between the antihypertensive agent groups in terms of the effects on white matter lesions. With this regard, randomized and prospective, large scaled trials are still needed. Key Words: Hypertension, white matter, dementia, cognitive dysfunction