Jichi Medical University, Japan
Michiaki Nagai graduated from the Jichi Medical University School of Medicine, and has been engaged in the cardiovascular medicine. Using volumetric analysis in MR SPGR imaging, he has been investigating the fields for target hypertensive organ damages including the relationships among hypertension, blood pressure variability, brain atrophy, cognitive impairment, and central autonomic nervous system including the insular cortex. He won the Japanese Society of Hypertension Award in the International Society of Hypertension 2006, and the Young Investigator’s Award in the 8th Japanese Neurocardiology Workshop 2007.
Although hypertension is well known as a cause of vascular dementia, recent findings highlight the role of hypertension in the pathogenesis of Alzheimer’s disease as well as mild cognitive impairment. Several studies reported that hypertension and high blood pressure variability are closely associated with cognitive impairment via injury of the small cerebral arteries indicating that long-standing hypertension constitutes a risk of brain matter atrophy or white matter lesions. Recently, in the HiroShima-Shobara-Soryo COhort (3SCO) study, we have shown that exaggerated visit-to-visit blood pressure variability was a significant indicator for the cognitive impairment in the elderly at high risk of cardiovascular disease. In several clinical trials, blood pressure-lowering with antihypertensive agents was suggested to reduce the risk of dementia or cognitive decline. From these stand points of views, we suggests that strict BP control as well as its variability control would be necessary to prevent cognitive impairment and dementia in the elderly hypertensive.