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RESEARCH PRODUCT
Investigation of antihypertensive class, dementia, and cognitive decline: a meta-analysis
Riitta AntikainenShea J. AndrewsPhillip J. TullyPhillip J. TullyCraig S. AndersonCraig S. AndersonCraig S. AndersonJari A. LaukkanenJari A. LaukkanenLina RydénCarol JaggerColleen J. MaxwellAndrew BoothSylvain SebertCarol A. DerbyTze Pin NgStella TrompetSevil YasarN BeckettMichelle C. CarlsonTessa Van MiddelaarTessa Van MiddelaarSirkka Keinänen-kiukaanniemiMaria M. CorradaChristopher TzourioJane WarwickJoanne C. BeerKenneth RockwoodAnn HeverRuth PetersRuth PetersPatrick G. KehoeMartin P.j. Van BoxtelIngmar SkoogMindy J. KatzFrançoise ForetteEric P. Moll Van CharanteLutgarde ThijsIris RawtaerMary GanguliHisatomi ArimaEdo RichardEdo RichardSebastian KöhlerEeva VaaramoSteven T. DekoskyJohan SkoogJohn ChalmersJohn ChalmersJean PetersKaarin J. AnsteyKaarin J. AnsteyCarol BrayneG. Peggy McfallRose Ann KennyRoberta VaccaroBlossom C. M. StephanErin WalshAnne Suzanne BertensHenry BrodatyAntonio GuaitaPerminder S. SachdevDavid B. HoganSetor K KunutsorWillem A. Van GoolClaudia H. KawasJan A StaessenRoger A. Dixonsubject
GerontologyMaleLATE-LIFEMEDLINEBLOOD-PRESSUREPsycINFOArticleELDERLY-PEOPLE03 medical and health sciences0302 clinical medicinehoitomenetelmätkohonnut verenpainemedicineDementiaHumansDRUGSCognitive Dysfunction030212 general & internal medicineCognitive declineHEALTHYAntihypertensive AgentsAgedMETABOLIC SYNDROMEAged 80 and overRISKbusiness.industrymeta-analyysiCognitionINCIDENT DEMENTIAMiddle Aged16. Peace & justicemedicine.diseaseDisorders of movement Donders Center for Medical Neuroscience [Radboudumc 3]PREVENTION3. Good healthClinical trialSystematic reviewMeta-analysisHypertensionCOHORT PROFILE[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologieDementiaFemaleNeurology (clinical)OLDbusiness030217 neurology & neurosurgerydementiadescription
ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.MethodsTo identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.ResultsOver 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.ConclusionOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.Clinical trials registrationThe review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2020-01-21 |