Issue: June 2020
Disclosures: Canavan and Hughes report no relevant financial disclosures
May 19, 2020
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BP-lowering benefits extend to dementia prevention

Issue: June 2020
Disclosures: Canavan and Hughes report no relevant financial disclosures
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Michelle Canavan

Patients taking antihypertensive medications had lower risk for incident dementia or cognitive impairment compared with control groups, according to a systematic review and meta-analysis published in JAMA.

“The benefits of lowering blood pressure go beyond prevention of heart disease and stroke and can now be extended to prevention of dementia,” Michelle Canavan, PhD, consultant geriatrician at University Hospital Galway in Ireland, told Healio. “Development of dementia and loss of functional independence are real concerns for many people. Our study results provide an added incentive to be adherent with blood pressure medications.”

Trials assessing BP lowering

Diarmaid Hughes, MB, BEng, of the HRB Clinical Research Facility at the National University of Ireland Galway and Saolta University Hospital Group, and colleagues analyzed data from 96,158 patients (mean age, 69 years; 42% women; mean systolic BP, 154 mm Hg; mean diastolic BP, 83.3 mm Hg).

Data were taken from 14 randomized clinical trials that compared BP lowering with antihypertensive medications with control, had more than 1,000 participants, had at least 1 year of follow-up and had information on outcomes including cognitive impairment, dementia, change in cognitive test scores and cognitive decline. Control groups consisted of alternative antihypertensive agents, placebo or higher BP targets.

“This study provides the most up-to-date review of the published evidence with the inclusion of two recent large randomized controlled trials,” Canavan said in an interview. “Before our study, the effect of blood pressure lowering was inconclusive, with some studies showing a benefit and some studies showing no effect on the risk for dementia.”

The primary outcome was cognitive impairment or dementia. Secondary outcomes included mean change in cognitive test scores and cognitive decline. Follow-up was conducted for a mean of 49.2 months.

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Risk for cognitive decline or impairment in patients who received antihypertensive medication compared with a control group.

Of the trials in this study, 12 included data on dementia incidence on follow-up, eight reported changes in cognitive test scores and eight reported on cognitive decline.

Compared with control, BP lowering with antihypertensive medications was significantly linked to a reduced risk for cognitive impairment or dementia (7% vs. 7.5%; OR = 0.93; 95% CI, 0.88-0.98; absolute risk reduction, 0.39%; 95% CI, 0.09-0.68; I2 = 0%). This decreased risk was also observed for cognitive decline (20.2% vs. 21.2%; OR = 0.93; 95% CI, 0.88-0.99; absolute risk reduction, 0.71%; 95% CI, 0.19-1.2; I2 = 36.1%).

The use of antihypertensive agents for BP lowering compared with control groups was not significantly linked to a difference in mean Mini-Mental State Examination score (mean difference, 0.44; 95% CI, 0.22 to 1.1; I2 = 98.5%) and the standardized mean cognitive score (standardized mean difference, 0.25; 95% CI, 0.1 to 0.61; P for heterogeneity < .01; I2 = 99.5%).

More effective measures needed

“The findings emphasize the need for more effective screening, prevention and treatment of hypertension, which remains suboptimal worldwide,” Canavan told Healio. “The message is simple: Get your blood pressure checked and treated if it is high to help protect your future cognitive health.” – by Darlene Dobkowski

For more information:

Michelle Canavan, PhD, can be reached at michelle.canavan@hse.ie.

Disclosures: Canavan and Hughes report no relevant financial disclosures. Please see the study all other authors’ relevant financial disclosures.