Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis.

Journal: JAMA network open

Volume: 6

Issue: 9

Year of Publication: 2023

Affiliated Institutions:  Faculty of Medicine, University of New South Wales, Sydney, Australia. The George Institute for Global Health, Sydney, Australia. Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg, Gothenburg, Sweden. Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany. Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain. World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria. Department of Neurology, Albert Einstein College of Medicine, Bronx, New York. Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea. Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Golgi Cenci Foundation, Abbiategrasso, Italy. First Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Athens, Greece. Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece. Department of Neurology, University Hospital of Larissa, Larissa, Greece. Department of Psychiatry, Indiana University School of Medicine, Indianapolis. Indiana Alzheimer Disease Research Center, Indiana Alzheimer Disease Research Center, Indianapolis. Institut for Neurosciences of Montpellier, University Montpellier, National Institute for Health and Medical Research, Montpellier, France. University of New South Wales, School of Psychology, Sydney, Australia. National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia. Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. National Institute for Health and Medical Research U, Institut de Recherche pour le Developpement UMR, Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University Limoges, Centre Hospitalier et Universitaire Limoges, Limoges, France. School of Medicine, University of California, San Francisco. Robert N. Butler Columbia Aging Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.

Abstract summary 

The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested.To 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.Longitudinal, 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).Participants 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.The 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.The 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.This 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.

Authors & Co-authors:  Lennon Matthew J MJ Lam Ben Chun Pan BCP Lipnicki Darren M DM Crawford John D JD Peters Ruth R Schutte Aletta E AE Brodaty Henry H Thalamuthu Anbupalam A Rydberg-Sterner Therese T Najar Jenna J Skoog Ingmar I Riedel-Heller Steffi G SG Röhr Susanne S Pabst Alexander A Lobo Antonio A De-la-Cámara Concepción C Lobo Elena E Bello Toyin T Gureje Oye O Ojagbemi Akin A Lipton Richard B RB Katz Mindy J MJ Derby Carol A CA Kim Ki Woong KW Han Ji Won JW Oh Dae Jong DJ Rolandi Elena E Davin Annalisa A Rossi Michele M Scarmeas Nikolaos N Yannakoulia Mary M Dardiotis Themis T Hendrie Hugh C HC Gao Sujuan S Carrière Isabelle I Ritchie Karen K Anstey Kaarin J KJ Cherbuin Nicolas N Xiao Shifu S Yue Ling L Li Wei W Guerchet Maëlenn M MM Preux Pierre-Marie PM Aboyans Victor V Haan Mary N MN Aiello Allison E AE Ng Tze Pin TP Nyunt Ma Shwe Zin MSZ Gao Qi Q Scazufca Marcia M Sachdev Perminder S S PSS

Study Outcome 

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Statistics
Citations :  Bloch MJ. Worldwide prevalence of hypertension exceeds 1.3 billion. J Am Soc Hypertens. 2016;10(10):753-754. doi:10.1016/j.jash.2016.08.006
Authors :  51
Identifiers
Doi : e2333353
SSN : 2574-3805
Study Population
Male,Female
Mesh Terms
Humans
Other Terms
Study Design
Cohort Study,Longitudinal Study,Cross Sectional Study
Study Approach
Systemic Review
Country of Study
Niger
Publication Country
United States