Daily Dose: Antihypertensive Treatment Throughout Late Life Lowers Risk of Dementia

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Earlier this week, we reported on a study published in JAMA Network Open that examined the associations of hypertension (HTN) history, use of antihypertensive treatments, and baseline measured blood pressure (BP) in late life (ie, aged >60 years) with dementia and the moderating factors of age, sex, and racial group.

The study

Investigators included longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium group, according to the study. Participants included persons without a dementia diagnosis at baseline, aged 60-110 years, and based in 15 different countries, including US, Brazil, Australia, China, Korea, France, and Greece.

Researchers grouped participants into 3 categories based on previous HTN diagnosis and baseline antihypertensive use: healthy controls, treated HTN, and untreated HTN. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. The key outcome was all-cause dementia, and study authors used mixed-effects Cox proportional hazards models to examine the associations between the exposures and all-cause dementia.

A total of 17 studies with 34 519 community-dwelling older adults (58.4% women; mean age, 72.5 years) and a mean follow-up of 4.3 years were included in the analysis.

Findings

Results from the main, partially adjusted analysis consisting of 14 studies showed that participants with untreated HTN had a 42% increased risk of dementia compared with healthy controls and 26% increased risk compared with those with treated HTN. There was no significant difference in dementia risk in participants with treated HTN compared with healthy controls.

Authors' comment

"Antihypertensive use was associated with decreased dementia risk in late-life individuals with hypertension; thus, dementia risk reduction may be 1 of the multiple goals of antihypertensive treatment in late-life (eg, prevention of ischemic heart disease, chronic kidney disease). A single measure of SBP or DBP at baseline had no significant association with late-life dementia risk, and, corroborating extant hypertension guidelines, it seems that more than 1 measure is needed to inform treatment."

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