Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life

Abstract

ImportanceThe utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested.ObjectivesTo assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group.Data Source and Study SelectionLongitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece).Data Extraction and SynthesisParticipants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines.Main Outcomes and MeasuresThe key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group.ResultsThe analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P = .001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P = .02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P = .07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses.Conclusions and RelevanceThis individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.

Rural‐urban disparities in the diagnosis and treatment of hypertension and diabetes among aging Indians

“… 19 The adverse impact of these conditions is much greater when they are undiagnosed or untreated. 20 , 21 However, proper diagnosis and treatment depend on various factors, which, in turn, could contribute to disparities between different population groups. It is essential to identify these disparities and understand the factors that contribute to them to put in practical strategies to prevent or mitigate their impact.…”

A latent clinical-anatomical dimension relating metabolic syndrome to brain structure and cognition

“…Collectively, these findings highlight the role of MetS in cognitive impairment and underscore the potential impact of therapies targeting cardiometabolic risk factors. Although the definitive role of such therapies in preventing cognitive decline is not yet fully established, emerging evidence suggests that these interventions can mitigate the adverse cognitive effects of MetS ( Veronese et al, 2017 ; Lennon et al, 2023 ; Gelber et al, 2013 ). As our results highlight obesity as a key factor in the observed clinical-anatomical relationship, we think that future studies should further investigate weight-reducing interventions to examine their effects on cognitive outcomes.…”

Nimodipine Protects Vascular and Cognitive Function in an Animal Model of Cerebral Small Vessel Disease

“…Indeed, some antihypertensive treatments have the beneficial effects of reducing the microanatomical changes in spontaneously hypertensive rats, 36 and also reducing cSVD pathologies. 37 Antihypertensives can delay cognitive impairment 37 and reduce the risk of dementia in patients, 38 , 39 but the beneficial effects are not ubiquitous. Thus, a clinical trial managing cardiovascular risks for over 6 years resulted in a significantly reduced incidence of hypertension but not of all-cause dementia.…”