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January 21, 2020; 94 (3) Article

Investigation of antihypertensive class, dementia, and cognitive decline

A meta-analysis

View ORCID ProfileRuth Peters, Sevil Yasar, Craig S. Anderson, View ORCID ProfileShea Andrews, Riitta Antikainen, Hisatomi Arima, Nigel Beckett, View ORCID ProfileJoanne C. Beer, Anne Suzanne Bertens, Andrew Booth, Martin van Boxtel, Carol Brayne, Henry Brodaty, Michelle C. Carlson, View ORCID ProfileJohn Chalmers, Maria Corrada, Steven DeKosky, Carol Derby, Roger A. Dixon, Françoise Forette, Mary Ganguli, Willem A. van Gool, Antonio Guaita, Ann M. Hever, David B. Hogan, View ORCID ProfileCarol Jagger, Mindy Katz, Claudia Kawas, Patrick G. Kehoe, View ORCID ProfileSirkka Keinanen-Kiukaanniemi, Rose Ann Kenny, View ORCID ProfileSebastian Köhler, Setor K. Kunutsor, Jari Laukkanen, Colleen Maxwell, G. Peggy McFall, Tessa van Middelaar, Eric P. Moll van Charante, View ORCID ProfileTze-Pin Ng, Jean Peters, View ORCID ProfileIris Rawtaer, Edo Richard, Kenneth Rockwood, View ORCID ProfileLina Rydén, Perminder S. Sachdev, Ingmar Skoog, View ORCID ProfileJohan Skoog, Jan A. Staessen, Blossom C.M. Stephan, Sylvain Sebert, Lutgarde Thijs, Stella Trompet, View ORCID ProfilePhillip J. Tully, View ORCID ProfileChristophe Tzourio, Roberta Vaccaro, Eeva Vaaramo, Erin Walsh, Jane Warwick, View ORCID ProfileKaarin J. Anstey
First published December 11, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008732
Ruth Peters
From Neuroscience Research Australia (R.P., K.J.A.); University of New South Wales (R.P., C.A., H.B., J.C., P.S.S., K.J.A.), Sydney, Australia; Johns Hopkins University (S.Y., M.C.C.), Baltimore, MD; The George Institute for Global Health (C.A., J.C.), Sydney, Australia; The George Institute China at Peking University Health Sciences Center (C.A.), Beijing, China; Icahn School of Medicine at Mount Sinai (S.A.), New York, NY; Center for Life Course Health Research/Geriatrics (R.A., S.K.-K., S.S., E.V.), University of Oulu; Medical Research Center Oulu (R.A.), Oulu University Hospital; Oulu City Hospital (R.A.), Finland; Department of Preventive Medicine and Public Health (H.A.), Fukuoka University, Japan; Guys and St Thomas' NHS Foundation Trust (N.B.), London, UK; University of Pittsburgh (J.C.B., M.G.), PA; Leiden University Medical Centre (A.S.B., S.T.), the Netherlands; University of Sheffield (A.B., J.P.), UK; School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology (M.v.B., S.K.), Maastricht University, the Netherlands; University of Cambridge (C.B.), UK; University of California (M.C., C.K.), Irvine; University of Florida (S.D.), Gainesville; Albert Einstein College of Medicine (C.D., M.K.), New York, NY; University of Alberta (R.A.D., G.P.M.), Edmonton, Canada; International Longevity Centre (F.F.), Paris, France; University of Amsterdam (W.A.v.G., E.P.M.v.C.), the Netherlands; Golgi Cenci Foundation (A.G., R.V.), Milan, Italy; Trinity College Dublin (A.H., R.A.K.), Ireland; University of Calgary (D.B.H.), Canada; Newcastle University (C.J., B.C.M.S.), Newcastle upon Tyne; University of Bristol (P.G.K., S.K.K.), UK; University of Eastern Finland (J.L.), Kuopio; Faculty of Sport and Health Sciences, University of Jyväskylä (J.L.), Finland; School of Pharmacy, University of Waterloo (C.M.), Ontario, Canada; Academic Medical Center (T.v.M., E.R.), Amsterdam; Donders Institute for Brain, Cognition and Behaviour (T.v.M., E.R.), Radboud University Medical Center, Nijmegen, the Netherlands; National University of Singapore (T.-P.N.); Sengkang General Hospital (I.R.), Singhealth Duke-NUS Academic Medical Centre, Singapore; Dalhousie University (K.R.), Halifax, Canada; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy (L.R., I.S.), and Department of Psychology (J.S.), Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden; University of Leuven (J.A.S., L.T.), Belgium; Bordeaux Population Health Research Center (P.J.T., C.T.), UMR 1219, CHU Bordeaux, University of Bordeaux, Inserm, France; University of Adelaide (P.J.T.); Australian National University (E.W.), Canberra, Australia; and University of Warwick (J.W.), Coventry, UK.
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Sevil Yasar
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Craig S. Anderson
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Jean Peters
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Citation
Investigation of antihypertensive class, dementia, and cognitive decline
A meta-analysis
Ruth Peters, Sevil Yasar, Craig S. Anderson, Shea Andrews, Riitta Antikainen, Hisatomi Arima, Nigel Beckett, Joanne C. Beer, Anne Suzanne Bertens, Andrew Booth, Martin van Boxtel, Carol Brayne, Henry Brodaty, Michelle C. Carlson, John Chalmers, Maria Corrada, Steven DeKosky, Carol Derby, Roger A. Dixon, Françoise Forette, Mary Ganguli, Willem A. van Gool, Antonio Guaita, Ann M. Hever, David B. Hogan, Carol Jagger, Mindy Katz, Claudia Kawas, Patrick G. Kehoe, Sirkka Keinanen-Kiukaanniemi, Rose Ann Kenny, Sebastian Köhler, Setor K. Kunutsor, Jari Laukkanen, Colleen Maxwell, G. Peggy McFall, Tessa van Middelaar, Eric P. Moll van Charante, Tze-Pin Ng, Jean Peters, Iris Rawtaer, Edo Richard, Kenneth Rockwood, Lina Rydén, Perminder S. Sachdev, Ingmar Skoog, Johan Skoog, Jan A. Staessen, Blossom C.M. Stephan, Sylvain Sebert, Lutgarde Thijs, Stella Trompet, Phillip J. Tully, Christophe Tzourio, Roberta Vaccaro, Eeva Vaaramo, Erin Walsh, Jane Warwick, Kaarin J. Anstey
Neurology Jan 2020, 94 (3) e267-e281; DOI: 10.1212/WNL.0000000000008732

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Abstract

Objective High 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.

Methods To 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.

Results Over 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.

Conclusion Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.

Clinical trials registration The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

Glossary

ACE-I=
angiotensin-converting enzyme inhibitors;
AHM=
antihypertensive medication;
ARB=
angiotensin receptor blockers;
BB=
β-blockers;
BP=
blood pressure;
CCB=
calcium channel blockers;
CI=
confidence interval;
DSM-III-R=
Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised;
DSM-IV=
Diagnostic and Statistical Manual of Mental Disorders, 4th edition;
MMSE=
Mini-Mental State Examination;
OR=
odds ratio;
RCI=
reliable change index;
RCT=
randomized controlled trial;
SBP=
systolic blood pressure

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • CME Course: NPub.org/cmelist

  • Received November 26, 2018.
  • Accepted in final form July 15, 2019.
  • © 2019 American Academy of Neurology
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Letters: Rapid online correspondence

  • Reader response: Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis
    • Tomoyuki Kawada, Professor, Nippon Medical School
    Submitted June 17, 2020
  • Reader response: An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis
    • Simona Lattanzi, MD, PhD, Marche Polytechnic University
    • Mauro Silvestrini, MD, Marche Polytechnic University
    Submitted December 30, 2019
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