Antihypertensive agents are linked to protection against dementia

  • Hughes D & al.
  • JAMA
  • 19 May 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Lowering BP with antihypertensive agents among older adults nets a small reduction in risk for dementia or cognitive impairment over the course of about 4 years, according to the findings of this meta-analysis.

Why this matters

  • Prevention and treatment options for dementia are limited.
  • Hypertension is prevalent.

Key results                                                                                                       

  • Mean baseline BP:
    • 154 mm Hg systolic.
    • 83.3 mm Hg diastolic.
  • Relative to control, BP lowering with antihypertensive agents was linked to reduced risk for:
    • Dementia or cognitive impairment:
      • 7.0% vs 7.5%.
      • OR, 0.93 (95% CI, 0.88-0.98).
      • Absolute risk reduction: 0.39% (95% CI, 0.09%-0.68%).
    • Cognitive decline (decrease in cognitive test score by an absolute value):
      • 20.2% vs 21.1%.
      • OR, 0.93 (95% CI, 0.88-0.99).
      • Absolute risk reduction: 0.71% (95% CI, 0.19%-1.2%).
  • No significant association seen for change in cognitive test scores.

Study design

  • Systematic review, meta-analysis of 14 randomized controlled trials with 96,158 participants (mean age, 69 years).
  • Randomization: BP lowering with agents vs control (placebo, alternative antihypertensive agents, or higher BP target).
  • Main outcome: dementia or cognitive impairment, with mean follow-up of 4.1 years.
  • Funding: Irish Clinical Academic Training Programme; Wellcome Trust; European Research Council; others.

Limitations

  • Heterogenous populations, interventions, outcome definitions.
  • Low dementia incidence.
  • Losses to follow-up.
  • Inability to identify optimal BP range for prevention.