Placebo-Controlled Trials of Blood Pressure–Lowering Therapies for Primary Prevention of Dementia

Staessen, Jan A.; Thijs, Lutgarde; Richart, Tom; Odili, Augustine N.; Birkenhäger, W. H.

doi:10.1161/hypertensionaha.110.165142

Cited by 76 publications

(58 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, meta-analyses also yielded negative results for AD risk reduction with ACE inhibitor/ARB regimens. 26, 27 In a systematic review of 4 double-blind, placebocontrolled RCTs including 15,936 hypertensive subjects, the incidence of dementia indicated no significant difference between treatment and placebo (236/7,767 vs. 259/7,660, OR 0.89, 95% CI 0.74, 1.07), and the change in MMSE did not indicate a benefit from treatment. In a meta-analysis of clinical trials in Japan, CCB-based antihypertensive regimens were found to reduce the risk of dementia more when compared with the controls, and even ACE inhibitor/ARB-based regimens.…”

Section: Discussionmentioning

confidence: 99%

Angiotensin-Receptor Blockers and Risk of Alzheimer’s Disease in Hypertension Population

Hsu

Huang

Chan

et al. 2013

Circ J

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Angiotensin-Receptor Blockers and Risk of Alzheimer’s Disease in Hypertension Population

Hsu

Huang

Chan

et al. 2013

Circ J

View full text Add to dashboard Cite

“…84 However, the Cochrane review of the randomized trials found no convincing evidence that antihypertensive treatment could reduce dementia risk, which is in line with another meta-analysis. 85,86 In view of these uncertainties, guidelines appropriately stress the importance of clinical judgment (Table 1), but, except for tolerability, do not specify what factors the clinician should take into account. One study showed that, in patients taking active treatment, total mortality was increased in patients with lower treated systolic and diastolic BP levels, and that these patients were characterized by decreases in body weight and hemoglobin concentration, suggesting deterioration of general health.…”

Section: Antihypertensive Drug Treatment In the Oldest Oldmentioning

confidence: 99%

Treatment of Hypertension in the Oldest Old

et al. 2014

View full text Add to dashboard Cite

A n 88-year-old woman with chronic hypertension was seen in the internal/geriatric medicine outpatient clinic. She had been treated for high blood pressure (BP) for ≈20 years with a low-dose thiazide, to which an angiotensin-converting enzyme-inhibitor had been added 5 years ago. In addition, after a possible transient ischemic attack 10 years ago, aspirin, omeprazole, and simvastatin had been added. She is known with mild cognitive impairment, which is stable with a mini-mental state examination score of 25, and a mild depression for which fluoxetine has been prescribed. In addition, she experienced 2 falls in the past 2 years; calcium/vitamin D and alendronate were started for the management of osteoporosis. On physical examination, she appears vital with a normal fluent gait and no signs of hemiparesis. Her BP is 165/75 mm Hg in the sitting position. Immediately after standing up from her chair, she feels dizzy for ≈10 seconds, but after 1 and 3 minutes, no orthostatic hypotension is found. Estimated glomerular filtration rate is 50 mL/min per 1.73 m 2 . Should antihypertensive treatment be intensified, left unaltered, or reduced?The oldest old, that is, persons aged ≥80 years, will be the fastest growing segment of the population for the next 40 years. By 2050, more than one quarter of all men and women aged ≥65 years in the Western world will be in the oldest old group. 1Despite longer life expectancy, the prevalence of various chronic diseases and functional impairment increases with age. As a result, populations of older individuals are often highly heterogeneous and individuals with same chronological age vary widely in health and functional ability. In other words, there is substantial heterogeneity in their biological age, and those at the higher end of biological age are often referred to as vulnerable or frail.BP rises with age, and ≈80% of people in Western societies aged ≥80 years have hypertension.2 Their hypertension is commonly characterized by elevated systolic BP, with often normal or even low diastolic BP. The widened pulse pressure (PP) is a reflection of increased arterial stiffness. Despite the large body of evidence in middle-aged populations, the predictive value of high BP in this rapidly growing older population is still debated, as is the question of whether hypertension should be treated, and if so, how intensively. Importantly, the current paradigm of lower is better may not apply to (untreated or treated) BP in the oldest old.In this concise narrative review, we summarize evidence from observational studies and randomized clinical trials. We conclude that biological age/frailty is becoming an important criterion for treatment decisions. Finally, we address what we think are the most pressing research questions for the coming years. Pathophysiology of BP Regulation in the Oldest OldAlthough hypertension in the oldest old may reflect a longstanding condition, often it manifests itself as a de novo abnormality. Data from the Framingham Heart Study indicate that the majority of patient...

show abstract

“…However, blood pressure reduction in randomized controlled trials (RCTs) demonstrated a complex association with reduced cognitive function, supporting the hypothesis that mechanisms beyond the blood-pressurelowering effect of antihypertensive medications may be involved. In fact, several RCTs examined the impact of different antihypertensive drug classes, also including ACE-Is, upon cognitive function, incident dementia, or both, although not as a primary outcome, with conflicting results (Forette et al 2002;Tzourio et al 2003;Lithell et al 2003;McGuinness et al 2006;Birns et al 2006;Peters et al 2008;McGuinness et al 2009;Staessen et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Angiotensin-converting enzyme inhibitors and incidence of mild cognitive impairment. The Italian Longitudinal Study on Aging

Solfrizzi

Scafato

Frisardi

et al. 2011

AGE

View full text Add to dashboard Cite

Midlife elevated blood pressure and hypertension contribute to the development of Alzheimer's disease (AD) and overall dementia. We sought to estimate whether angiotensin-converting enzyme AGE (2013) inhibitors (ACE-Is) reduced the risk of developing mild cognitive impairment (MCI) in cognitively normal individuals. In the Italian Longitudinal Study on Aging, we evaluated 1,445 cognitively normal individuals treated for hypertension but without congestive heart failure from a population-based sample from eight Italian municipalities with a 3.5-year follow-up. MCI was diagnosed with current clinical criteria. Dementia, AD, and vascular dementia were diagnosed based on DSM-IIIR criteria, NINCDS-ADRDA criteria, and ICD-10 codes. Among 873 hypertensiontreated cognitively normal subjects, there was no significant association between continuous exposure to all ACE-Is and risk of incident MCI compared with other antihypertensive drugs [hazard ratio (HR), 0.45, 95% confidence interval (CI), 0.16-1.28]. Captopril exposure alone did not significantly modify the risk of incident MCI (HR, 1.80, 95% CI,). However, the enalapril sub-group alone (HR, 0.17, 95% CI, 0.04 -0.84) or combined with the lisinopril sub-group (HR, 0.27, 95% CI, 0.08-0.96), another ACE-I structurally related to enalapril and with similar potency, were associated with a reduced risk of incident MCI. Study duration exposure to ACE-Is as a "class" was not associated with incident MCI in older hypertensive adults. However, within-class differences linked to different chemical structures and/or drug potencies may exist, with a possible effect of the enalapril and lisinopril sub-groups in reducing the risk of incident MCI.

show abstract

Placebo-Controlled Trials of Blood Pressure–Lowering Therapies for Primary Prevention of Dementia

Cited by 76 publications

References 14 publications

Angiotensin-Receptor Blockers and Risk of Alzheimer’s Disease in Hypertension Population

Angiotensin-Receptor Blockers and Risk of Alzheimer’s Disease in Hypertension Population

Treatment of Hypertension in the Oldest Old

Angiotensin-converting enzyme inhibitors and incidence of mild cognitive impairment. The Italian Longitudinal Study on Aging

Contact Info

Product

Resources

About