While hypertension clearly has a detrimental effect on cardiovascular health, it is interesting to investigate how poor cardiovascular health affects other areas of the body, such as the brain. As we know our cardiovascular system is an open system, meaning that the blood reaches outwards to the body to many lymphatic tissues. Large epidemiological studies have shown that high blood pressure, especially during midlife, can accelerate cognitive decline and increase risk for dementia and Alzheimer’s disease. This occurs because high blood pressure can lead to hypertension which causes decreased circulation in the brain. The decreased perfusion in the brain inhibits the brain’s ability to clear potentially harmful proteins like β-amyloid which are associated with dementia and Alzheimer’s Disease when they start to build-up and create β-amyloid plaques.
With this knowledge, researchers have been looking into the possibility of antihypertension medicines that can decrease the risk of dementia or Alzheimer’s Disease. It has been found that antihypertensive medication, especially ACE inhibitors and diuretics, may be helpful in reducing the risk for and progression of dementia. The use of diuretics and ACE inhibitors increases the concentration of salt in the blood and therefore decreases the amount of water retention. The decrease of water in the blood decreases blood pressure and allows better perfusion of blood into the brain.
When thinking of different systems in the body such as the cardiovascular and nervous systems, it is crucial to not think of them as independent systems without any other influences, especially when thinking about diseases and how medications interact with the body.
Shah, K., Qureshi, S. U., Johnson, M., Parikh, N., Schulz, P. E., & Kunik, M. E. (2009). Does use of antihypertensive drugs affect the incidence or progression of dementia? A systematic review. The American journal of geriatric pharmacotherapy, 7(5), 250-261.
Walker, K. A., Power, M. C., & Gottesman, R. F. (2017). Defining the relationship between hypertension, cognitive decline, and dementia: a review. Current hypertension reports, 19(3), 1-16.
Diuretics are commonly prescribed to treat high blood pressure, but did you know that one of the diuretics called spironolactone has also been used off-label for decades to treat adult female hormonal acne? The reason is because spironolactone also has anti-androgenic effects. It binds to androgen receptors on oil glands blocking testosterone from binding. If testosterone is unable to bind and stimulate the oil glands, then that prevents excess oil production. How does this relate to acne? Well, acne is caused by accumulation of dead skin cells and sebum/oil that clog pores. Some common side effects of this medication include diuresis (increased urine production), menstrual irregularities, breast tenderness, and dizziness. Serious side effects include hyperkalemia. Like with other acne treatments such as isotretinoin, spironolactone should not be taken if you are pregnant.
ReplyDeleteSearle, N. T., Al-Niami, F., Ali, R. F. (2020). Spironolactone in Dermatology: Uses in Acne and Beyond. Clinical and Experimental Dermatology, 45 (8), 986-993. doi: 10.1111/ced.14340
Zaenglein L. A. et al. Guidelines of Care For the Management of Acne Vulgaris.” Journal of the American Academy of Dermatology, 74 (5), 945-973. doi: https://doi.org/10.1016/j.jaad.2015.12.037