The treatment of hypertension in people with dementia: a systematic review of observational studies

Welsh, Tomas; Gladman, John; Gordon, Adam L

doi:10.1186/1471-2318-14-19

Cited by 44 publications

(32 citation statements)

References 32 publications

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“…An analysis of observational studies suggested the prevalence of hypertension in those with dementia was 45 %, with target BP achieved in 55 %; the majority were receiving medications, diuretics being most common. The findings suggest the need for more work to establish a riskbenefit ratio in the setting of dementia [126]. A systematic review of 18 longitudinal studies involving over 1.3 million subjects, average age 74 years, suggested that antihypertensive drugs, especially CCBs and renin-angiotensin system blockers may help in the prevention of cognitive decline and dementia.…”

Section: Dementiamentioning

confidence: 99%

Tolerability of Antihypertensive Medications in Older Adults

Dharmarajan

2015

Drugs Aging

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Several guidelines for hypertension have recently undergone revisions to incorporate an approach providing choices of medications based on age, race, and specific situations where hypertension may co-exist with disorders such as diabetes, coronary artery disease, heart failure and chronic kidney disease. Initial recommendations include diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers; beta blockers are favored in some guidelines and are a choice in specific settings. Within the classes of drugs, several antihypertensive agents provide options. This review discusses antihypertensive drugs by class, including adverse effects and tolerability, with preferences in older adults and specific settings. Adverse drug events from antihypertensive medications are discussed by class and where applicable for specific agents. Data from select studies pertinent to tolerability and adverse effects are presented in tables for several classes of drugs. The rationale for nonadherence to medication is reviewed, including the roles played by tolerability and adverse drug effects. Antihypertensive therapy in typical settings in older adults is discussed; they include hypertension in association with impaired cognition, depression, diabetes, sexual dysfunction, and falls. The key to successful therapy and tolerability is to promote a healthy lifestyle in conjunction with medications as the approach, thereby also lowering the adverse drug effects. The eventual choice of the specific drug(s) is based on risks, benefits, and patient preferences, and is best tailored for each older adult.

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Section: Dementiamentioning

confidence: 99%

Tolerability of Antihypertensive Medications in Older Adults

Dharmarajan

2015

Drugs Aging

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“…Our results are therefore biologically plausible as regular sauna bathing is associated with improved vascular endothelial function [8], which also leads to reduced inflammation. Additionally, sauna bathing may be beneficial in the reduction of high systemic blood pressure and elevated pulse pressure, which are also well-known risk factors for dementia [12,19]. Skin blood flow usually increases leading to a higher cardiac output with an increased body temperature during sauna bathing.…”

Section: Discussionmentioning

confidence: 99%

Sauna bathing is inversely associated with dementia and Alzheimer's disease in middle-aged Finnish men

et al. 2016

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Background there are no previous studies linking repeated heat exposure of sauna and the risk of memory diseases. We aimed to investigate whether frequency of sauna bathing is associated with risk of dementia and Alzheimer's disease. Setting prospective population-based study. Methods the frequency of sauna bathing was assessed at baseline in the Kuopio Ischaemic Heart Disease population-based prospective cohort study of 2,315 apparently healthy men aged 42–60 years at baseline, with baseline examinations conducted between 1984 and 1989. Hazard ratios (HRs) with 95% confidence intervals (CIs) for dementia and Alzheimer's disease were ascertained using Cox-regression modelling with adjustment for potential confounders. Results during a median follow-up of 20.7 (interquartile range 18.1–22.6) years, a total of 204 and 123 diagnosed cases of dementia and Alzheimer's disease were respectively recorded. In analysis adjusted for age, alcohol consumption, body mass index, systolic blood pressure, smoking status, Type 2 diabetes, previous myocardial infarction, resting heart rate and serum low-density lipoprotein cholesterol, compared with men with only 1 sauna bathing session per week, the HR for dementia was 0.78 (95% CI: 0.57–1.06) for 2–3 sauna bathing sessions per week and 0.34 (95% CI: 0.16–0.71) for 4–7 sauna bathing sessions per week. The corresponding HRs for Alzheimer's disease were 0.80 (95% CI: 0.53–1.20) and 0.35 (95% CI: 0.14–0.90). Conclusion in this male population, moderate to high frequency of sauna bathing was associated with lowered risks of dementia and Alzheimer's disease. Further studies are warranted to establish the potential mechanisms linking sauna bathing and memory diseases.

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“…There is recent evidence that patients with cognitive impairment, frailty and those in care homes require special consideration regarding antihypertensive prescribing [25][26][27]. For example in older patients with frailty (as indicated by slower walking speed) higher BP was not associated with higher mortality, whereas in patients with higher walking speeds high BP was associated with increased mortality [24].…”

Section: Discussionmentioning

confidence: 99%

118older People Remain on Blood Pressure Agents Despite Being Hypotensive Resulting in Increased Mortality and Hospital Admission

et al. 2017

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Background: the use of antihypertensive medication in older people in order to prevent cardiovascular events is well established. The use of such agents has been encouraged by incentive schemes in the United Kingdom including the Quality and Outcomes Framework. In addition, many guidelines recommend good blood pressure (BP) control in the elderly. However, in older people antihypertensives can cause adverse effects related to hypotension. Aim: the aim of this study was to assess the prevalence of low BP and impact on outcomes, particularly in the presence of antihypertensive treatment, in a primary care population of older people. Design: a retrospective observational cohort study in people over the age of 70 years registered with primary care providers in Kent. Results: a total of 11,167 patients over 70 years old were analysed, 6,373 female (57%). Systolic blood pressure (SBP) was below 120 mmHg in 1,297 people (844 on antihypertensives), below 110 mmHg in 474 (313 on antihypertensives) and below 100 mmHg in 128 (89 on antihypertensives). Hypotension was independently associated with mortality, acute kidney injury and hospital admission.Conclusions: the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people.

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The treatment of hypertension in people with dementia: a systematic review of observational studies

Cited by 44 publications

References 32 publications

Tolerability of Antihypertensive Medications in Older Adults

Tolerability of Antihypertensive Medications in Older Adults

Sauna bathing is inversely associated with dementia and Alzheimer's disease in middle-aged Finnish men

118older People Remain on Blood Pressure Agents Despite Being Hypotensive Resulting in Increased Mortality and Hospital Admission

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