Antihypertensives lower dementia risk in hypertensive patients

  • Lancet Neurol.

  • International Clinical Digest
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Takeaway

  • Older adults with high BP had reduced risks for dementia and Alzheimer’s disease (AD) if they used antihypertensive medication, regardless of drug class.

Why this matters

  • Limited options for preventing and treating dementia.

Key results

  • With median follow-up ranging from 7 to 22 years, 3728 incident cases of dementia and 1741 incident cases of Alzheimer’s disease.
  • Among the 50% of participants having baseline high BP, antihypertensive medication users had reduced adjusted risks for:
    • Dementia (HR, 0.88; 95% CI, 0.79-0.98).
    • Alzheimer’s disease (HR, 0.84; 95% CI, 0.73-0.97).
  • No significant differences in risk between 1 drug class vs all others.
  • APOE ε4 carriers with high BP who used antihypertensive medication had more marked reduction in dementia risk (HR, 0.77; 95% CI, 0.64-0.93).
  • In contrast, among participants having normal BP, antihypertensive medication use did not protect against dementia or Alzheimer’s disease.

Study design

  • Meta-analysis of individual participant data from 6 large prospective observational cohort studies among 31,090 community-dwelling dementia-free adults older than 55 years published 1980-2018.
  • Main outcomes: all-cause dementia, Alzheimer’s disease.
  • Funding: Alzheimer’s Drug Discovery Foundation; National Institute on Aging Intramural Research Program.

Limitations

  • Potential misclassification of dementia type.
  • Survival may have differed by medication use.
  • Possible residual confounding.