***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objective To investigate whether angiotensin receptor blockers protect against  Alzheimer ’s disease and dementia or reduce the progression of both diseases . Design Prospect i ve cohort analysis . Setting Administrative data base of the US Veteran Affairs , 2002 - 6 . Population 819 491 predominantly male participants ( 98 % ) aged 65 or more with cardiovascular disease . Main outcome measures Time to incident Alzheimer ’s disease or dementia in three cohorts ( angiotensin receptor blockers , lisinopril , and other cardiovascular drugs , the “ cardiovascular comparator ” ) over a four year period ( fiscal years 2003 - 6 ) using Cox proportional hazard models with adjustments for age , diabetes , stroke , and cardiovascular disease . Disease progression was the time to admission to a nursing home or death among participants with pre-existing Alzheimer ’s disease or dementia . Results Hazard rates for incident dementia in the angiotensin receptor blocker group were 0.76 ( 95 % confidence interval 0.69 to 0.84 ) compared with the cardiovascular comparator and 0.81 ( 0.73 to 0.90 ) compared with the lisinopril group . Compared with the cardiovascular comparator , angiotensin receptor blockers in patients with pre-existing Alzheimer ’s disease were associated with a significantly lower risk of admission to a nursing home ( 0.51 , 0.36 to 0.72 ) and death ( 0.83 , 0.71 to 0.97 ) . Angiotensin receptor blockers exhibited a dose-response as well as additive effects in combination with angiotensin converting enzyme inhibitors . This combination compared with angiotensin converting enzyme inhibitors alone was associated with a reduced risk of incident dementia ( 0.54 , 0.51 to 0.57 ) and admission to a nursing home ( 0.33 , 0.22 to 0.49 ) . Minor differences were shown in mean systolic and diastolic blood pressures between the groups . Similar results were observed for Alzheimer ’s disease . Conclusions Angiotensin receptor blockers are associated with a significant reduction in the incidence and progression of Alzheimer ’s disease and dementia compared with angiotensin converting enzyme inhibitors or other cardiovascular drugs in a predominantly male population BACKGROUND AND PURPOSE White matter lesions ( WML ) may result from cerebral hypoperfusion or ischemia . We investigated the association of WML with blood pressure , hypertension , and its treatment and control . METHODS A r and om sample of 1920 participants aged 55 to 72 years in the Atherosclerosis Risk in Communities Study ( ARIC ) was examined . Spin-density 1.5-T MRI scan images were coded from 0 for normal to 9 for most severe WML . Hypertension was defined as systolic or diastolic pressure > or = 140/90 mm Hg or use of antihypertensive medication . RESULTS The percentages of persons with WML grade s 0 through 2 and 3 through 9 , respectively , were as follow : normotensive , 92.4 % and 7.6 % , versus all hypertensive subjects , 83 % and 17 % ( P < .001 ) ; and treated controlled hypertensive , 86 % and 14 % , versus treated uncontrolled hypertensive subjects , 76 % and 24 % ( P = .003 ) . Multivariable adjusted odds ratios ( 95 % confidence intervals ) for WML grade > or = 3 relative to normotensive subjects was 2.34 ( 1.71 to 3.20 ) for all hypertensives , 1.99 ( 1.19 to 3.08 ) for untreated hypertensives , 1.94 ( 1.32 to 2.85 ) for treated controlled hypertensives , and 3.40 ( 2.30 to 5.03 ) for treated uncontrolled hypertensives . After additional adjustment for hypertension duration , treatment , and control status , the odds ratios ( 95 % confidence intervals ) for a 1 SD increase of systolic and diastolic blood pressure were 1.43 ( 1.11 to 1.85 ) and 1.16 ( 0.94 to 1.43 ) , respectively . CONCLUSIONS Hypertension is associated with increased odds of WML , and treated uncontrolled hypertensive subjects have greater odds of WML than those with treated controlled hypertension . The data suggest that the level of blood pressure , especially systolic blood pressure , is related to WML , additional to the effects of categorically defined hypertension and its treatment and control status BACKGROUND Previous studies have reported a higher prevalence of dementia in persons with low blood pressure . OBJECTIVE To examine whether low blood pressure is prospect ively associated with the occurrence of Alzheimer disease and dementia in elderly people . SUBJECTS AND METHODS A community-based , dementia-free cohort ( n = 1270 ) aged 75 to 101 years was longitudinally examined twice within 6 years to detect incident dementia using the Diagnostic and Statistical Manual of Mental Disorders , Revised Third Edition criteria . Cox proportional hazards models were used to analyze blood pressure in association with dementia after adjustment for several potential confounders . RESULTS During the 6-year period , 339 subjects were diagnosed with dementia , including 256 persons with Alzheimer disease . Subjects with very high systolic pressure ( > 180 vs 141 - 180 mm Hg ) had an adjusted relative risk of 1.5 ( 95 % confidence interval [ CI ] , 1.0 - 2.3 ; P = .07 ) for Alzheimer disease , and 1.6 ( 95 % CI , 1.1 - 2.2 ) for dementia . Low systolic pressure ( < /=140 mm Hg ) was not related to incident dementia . In contrast , high diastolic pressure ( > 90 mm Hg ) was not associated with dementia incidence , whereas extremely low diastolic pressure ( < /=65 vs 66 - 90 mm Hg ) produced an adjusted relative risk of 1.7 ( 95 % CI , 1.1 - 2.4 ) for Alzheimer disease and 1.5 ( 95 % CI , 1.0 - 2.1 ; P = .03 ) for dementia . The latter association was pronounced particularly in persons who used antihypertensive drugs . CONCLUSIONS Both low diastolic and high systolic pressure are associated with an increased risk of Alzheimer disease and dementia in this elderly population . The atherosclerotic process may explain the observed associations . In addition , low diastolic pressure may increase dementia risk by affecting cerebral perfusion Abstract Objective : To determine the effect of the angiotensin converting enzyme inhibitor ramipril on the secondary prevention of stroke . Design : R and omised controlled trial with 2 × 2 factorial design . Setting : 267 hospitals in 19 countries . Participants : 9297 patients with vascular disease or diabetes plus an additional risk factor , followed for 4.5 years as part of the HOPE study . Outcome measures : Stroke ( confirmed by computed tomography or magnetic resonance imaging when available ) , transient ischaemic attack , and cognitive function . Blood pressure was recorded at entry to the study , after 2 years , and at the end of the study . Results : Reduction in blood pressure was modest ( 3.8 mm Hg systolic and 2.8 mm Hg diastolic ) . The relative risk of any stroke was reduced by 32 % ( 156 v 226 ) in the ramipril group compared with the placebo group , and the relative risk of fatal stroke was reduced by 61 % ( 17 v 44 ) . Benefits were consistent across baseline blood pressures , drugs used , and subgroups defined by the presence or absence of previous stroke , coronary artery disease , peripheral arterial disease , diabetes , or hypertension . Significantly fewer patients on ramipril  had cognitive or functional impairment . Conclusion : Ramipril  reduces the incidence of stroke in patients at high risk , despite a modest reduction in blood pressure . What is already known on this topic Treatment with aspirin and lowering blood pressure reduce the incidence of stroke What this study adds Ramipril , an angiotensin converting enzyme inhibitor , reduces strokes in patients at high risk whose blood pressure is not elevated , despite only a modest lowering of blood pressure The benefits are observed even when patients receive aspirin and other blood pressure lowering BACKGROUND Results of previous studies of white older adults suggest that antihypertensive medications preserve cognition . We assessed the long-term effect of antihypertensive medications on cognitive function in a community sample of African American older adults . METHODS We conducted longitudinal surveys and clinical assessment of cognitive function in a r and om sample of 2212 community-dwelling African Americans 65 years and older . We identified 1900 participants without evidence of cognitive impairment at baseline , 1617 of whom had subsequent follow-up information , and 946 of whom had blood pressure measurements .  Cognitive function was measured at baseline and at 2 and 5 years by means of scores on the Community Screening Instrument for Dementia and neuropsychological and clinical assessment for dementia and cognitive impairment . Prescription and nonprescription medication use was derived from in-home inspection of medications and participant and informant reports . RESULTS Of 1900 participants , 288 ( 15.2 % ) developed incident cognitive impairment . Using logistic regression to control for the effects of age , sex , education , baseline cognitive scores , and hypertension and angina or myocardial infa rct ion , we found that antihypertensive medications reduced the odds of incident cognitive impairment by 38 % ( odds ratio , 0.62 ; 95 % confidence interval , 0.45 - 0.84 ) . Corresponding analysis using blood pressure measurements on the subset of participants was inconclusive . CONCLUSION Antihypertensive medication use is associated with preservation of cognitive function in older African American adults Objective : To determine the associations between classes of antihypertensive medication use and the risk of cognitive impairment  among elderly hypertensive men . Methods : The Honolulu-Asia Aging Study is a prospect i ve , community-based cohort study of Japanese American men conducted in Honolulu , Hawaii . We examined 2,197 participants ( mean age 77 years at cohort entry , 1991–1993 , followed through September 2010 ) with hypertension and without dementia or cognitive impairment at baseline , who provided information on medication use .  Cognitive function was assessed at 7 st and ardized examinations using the Cognitive Abilities Screening Instrument ( CASI ) . Cognitive impairment was defined as a CASI score < 74 . Results : A total of 854 men developed cognitive impairment  ( median follow-up , 5.8 years ) . β-Blocker use as the sole antihypertensive drug at baseline was consistently associated with a lower risk of cognitive impairment ( incidence rate ratio [ IRR ] 0.69 ; 95 % confidence interval [ CI ] 0.50–0.94 ) , as compared with men not taking any antihypertensive medications , adjusting for multiple potential confounders . The use of diuretics , calcium channel blockers , angiotensin-converting enzyme inhibitors , or vasodilators alone was not significantly associated with cognitive impairment . Results were similar excluding those with cardiovascular disease or < 1 year of follow-up , and additionally adjusting for pulse pressure , heart rate , baseline and midlife systolic blood pressure , and midlife antihypertensive treatment ( IRR 0.65 ; 95 % CI 0.45–0.94 ) . The association between β-blocker use and cognitive impairment was stronger among men with diabetes , men aged > 75 years , and those with pulse pressure ≥70 mm Hg . Conclusions : β-blocker use is associated with a lower risk of developing cognitive impairment in elderly Japanese American men A prospect i ve analysis of risk factors for Alzheimer 's disease was a major objective of the Canadian Study of Health and Aging , a nationwide , population -based study . Of 6,434 eligible subjects aged 65 years or older in 1991 , 4,615 were alive in 1996 and participated in the follow-up study . All participants were cognitively normal in 1991 when they completed a risk factor question naire . Their cognitive status was reassessed 5 years later by using a similar two-phase procedure , including a screening interview , followed by a clinical examination when indicated . The analysis included 194 Alzheimer 's disease cases and 3,894 cognitively normal controls . Increasing age , fewer years of education , and the apolipoprotein E epsilon4 allele were significantly associated with increased risk of Alzheimer 's disease . Use of nonsteroidal anti-inflammatory drugs  ,  wine consumption , coffee consumption  , and  regular physical activity  were associated with a reduced risk of Alzheimer 's disease . No statistically significant association was found for family history of dementia , sex , history of depression , estrogen replacement therapy , head trauma , antiperspirant or antacid use , smoking , high blood pressure , heart disease , or stroke . The protective associations warrant further study . In particular , regular physical activity could be an important component of a preventive strategy against Alzheimer 's disease and many other conditions BACKGROUND Whether the treatment of patients with hypert 
    Output:
    
Antihypertensive medication could decrease the risk of not only vascular dementia but also Alzheimer ’s disease .
Conclusion Antihypertensive drugs , particularly calcium channel blockers and renin – angiotensin system blockers , may be beneficial in preventing cognitive decline and dementia .