Hypertension and cognitive impairment: relationship and management approaches

Hypertension (HTN) is currently regarded as the most prevalent risk factor, which can lead to both stroke and cognitive impairment. The versatility and similarity of HTN and chronic cerebral ischemia (CCI) pathogenetic mechanisms should be considered in prevention and treatment strategies. The severity of pathological changes in central nervous system (CNS) depends on the degree of HTN and concomitant neurological pathologies. The drug effects on both vascular and cognitive dysfunctions as well as comorbidities and polypharmacy should be considered. The use of agents with polymodal pleiotropic effects both at metabolic and circulation levels appears feasible and rewarding ethylmethylhydroxypyridine malate can be recommended in HTN co-existent with CCI and cognitive disorders. The combination therapy of ethylmethylhydroxypyridine malate with antihypertensive, anti-ischemic drugs, anticoagulants and statins has been proven to be safe, shows low risk of adverse events and can be implemented in a wide range of vascular and comorbid diseases.