Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Antihypertensive Drug Therapy and Dementia Risk in Older Adults
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Evidence exists that lowering high blood pressure reduces the risk of dementia. However, the generalizability of this evidence to old patients from the general population remains uncertain.
OBJECTIVES
This study sought to evaluate the effect of antihypertensive drug treatment on the risk of dementia in a heterogeneous group of new users of antihypertensive drugs.
METHODS
A nested case-control study was carried out by including the cohort of 215,547 patients from Lombardy, Italy, aged ≥65 years, who started taking antihypertensive drugs between 2009 and 2012. Cases were the 13,812 patients (age 77.5 ± 6.6 years; 40% men) who developed dementia or Alzheimer's disease during follow-up (up to 2019). For each case, 5 control subjects were selected to be matched for sex, age, and clinical status. Exposure to drug therapy was measured by the proportion of the follow-up covered by antihypertensive drugs. Conditional logistic regression was used to model the outcome risk associated with exposure to antihypertensive drugs.
RESULTS
Exposure to treatment was inversely associated with the risk of dementia. Compared with patients with very low exposure, those with low, intermediate, and high exposure exhibited a 2% (95% CI: -4% to 7%), 12% (95% CI: 6%-17%), and 24% (95% CI: 19%-28%) risk reduction, respectively. This was also the case for very old (aged ≥85 years) and frail patients (ie, those characterized by a high mortality risk at 1 year).
CONCLUSIONS
In the old fraction of the general population, antihypertensive drug treatment is associated with a lower risk of dementia. This was also the case in very old and frail patients.
Additional Info
Disclosure statements are available on the authors' profiles:
Risk of Dementia During Antihypertensive Drug Therapy in the Elderly
J Am Coll Cardiol 2024 Apr 02;83(13)1194-1203, F Rea, G Corrao, G ManciaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The relationship between hypertension and dementia has been debated for a long time. Firstly, epidemiological studies showed a higher risk of dementia among patients with hypertension. Recently, the SPRINT MIND trial and a meta-analysis of randomized trials found that a reduction in blood pressure by antihypertensive treatment is linked to a delay of mild cognitive impairments and a reduction in the risk of dementia. However, the generalizability of these findings to the general population may be questioned because of the strict eligibility criteria of the trials.
Rea and colleagues add some evidence to this issue by showing that the beneficial effect of antihypertensive drug treatment in delaying the onset of dementia extended to older patients and those with frailty from the general population. This study, involving more than 200,000 patients, sought to assess the effect of antihypertensive drug treatment on the risk of dementia by comparing different exposures to antihypertensive drugs assessed through the proportion of the follow-up covered by drugs. Over a follow-up period of up to 11 years, the investigators found that higher exposures to antihypertensive treatment were associated with progressively lower dementia risk. This trend was observed in both sexes, in all age strata (including patients aged 85 years or older), and regardless of the patient's baseline clinical status (including those characterized by a very high risk of early mortality).
Although these results are interesting, questions remain. For example, future studies should investigate the extent of the blood pressure reduction required to translate into the highest anti-dementia effect. In addition, potential differences between antihypertensive drugs should also be explored. In the meantime, because lowering blood pressure reduces the risk of dementia as well as myocardial infarction and stroke, physicians should constantly monitor their patients in order to improve the management of hypertension.