Cognitive Decline and Dementia Recommendation for Prevention of Cognitive Decline and Dementia References that support the recommendation are summarized in Online Data Supplement 56. COR LOE Recommendation IIa B-R 1. In adults with hypertension, BP lowering is reasonable to prevent cognitive decline and Synopsis Dementia is a leading cause of mortality and placement into nursing homes and assisted living facilities, affecting >46 mil- lion individuals globally and 5 million persons in the United States, a number that is expected to double by 2050.S11.3-7 A 5-year delay in onset of dementia would likely decrease the number of cases of incident dementia by about 50% after Vascular disease and its risk factors are implicated in a large proportion of patients with demen- tia, including those with Alzheimer s dementia.S11.3-9 S11.3-11 Hypertension is also the primary risk factor for small-vessel Most observational studies have suggested that better control of SBP may reduce Alzheimer s disease and other dementias, and the evidence is stronger for BP lowering in middle age than in older adults.S11.3-9,S11.3-16 Clinical trials with dementia assessment have evaluated all-cause dementia but not Alzheimer s disease specifically. However, all of these trials have methodological issues, such as low power, insuf- ficient follow-up length, and inadequately designed dementia assessment batteries. Recommendation-Specific Supportive Text 1. Five clinical trials of BP lowering have included as- sessment for incident dementia. Of these 5 trials, 4 Table 20. Intravenous Antihypertensive Drugs for Treatment of Hypertensive Emergencies in Patients With Selected Comorbidities Comorbidity Preferred Drug(s)* Comments Acute aortic dissection Esmolol, labetalol Requires rapid lowering of SBP to 120 mm Hg.Beta blockade should precede vasodilator (eg, nicardipine or nitroprusside) administration, if needed for BP control or to prevent reflex tachycardia or inotropic effect; SBP 120 mm Hg should be achieved within 20 min. 