Hypertension is an important risk factor for Alzheimer's disease (AD) and all-cause dementia. The mechanisms underlying this association are unclear. Hypertension may be associated with AD neuropathological changes (ADNC), but reports are sparse and inconsistent. This systematic review included 15 autopsy studies (n = 5879) from observational cohorts. Studies were highly heterogeneous regarding populations, follow-up duration, hypertension operationalization, neuropathological methods, and statistical analyses. Hypertension seems associated with higher plaque and tangle burden, but results are inconsistent. Four studies (n = 3993/5879; 68%), reported clear associations between hypertension and ADNC. Another four suggested that antihypertensive medication may protect against ADNC. Larger studies with longer follow-up reported the strongest relationships. Our findings suggest a positive association between hypertension and ADNC, but effects may be modest, and possibly attenuate with higher hypertension age and antihypertensive medication use. Investigating interactions among plaques, tangles, cerebrovascular pathology, and dementia may be key in better understanding hypertension's role in dementia development.

中文翻译：

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尸检时的高血压和阿尔茨海默病病理学：系统评价

高血压是阿尔茨海默病（AD）和全因痴呆的重要危险因素。这种关联的机制尚不清楚。高血压可能与 AD 神经病理改变 (ADNC) 有关，但报道很少且不一致。这项系统评价包括来自观察队列的 15 项尸检研究 ( n  = 5879)。研究在人群、随访持续时间、高血压手术、神经病理学方法和统计分析方面存在高度异质性。高血压似乎与较高的斑块和缠结负担相关，但结果并不一致。四项研究 ( n  = 3993/5879; 68%) 报告了高血压与 ADNC 之间的明确关联。另外四人建议抗高血压药物可以预防 ADNC。更大规模、更长时间随访的研究报告了最强的关系。我们的研究结果表明，高血压与 ADNC 之间存在正相关关系，但影响可能不大，并且可能会随着高血压年龄的增加和抗高血压药物的使用而减弱。研究斑块、缠结、脑血管病理学和痴呆之间的相互作用可能是更好地了解高血压在痴呆发展中的作用的关键。