Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life

Author:

Lennon Matthew J.12,Lam Ben Chun Pan123,Lipnicki Darren M.12,Crawford John D.12,Peters Ruth456,Schutte Aletta E.47,Brodaty Henry128,Thalamuthu Anbupalam12,Rydberg-Sterner Therese910,Najar Jenna911,Skoog Ingmar911,Riedel-Heller Steffi G.12,Röhr Susanne121314,Pabst Alexander12,Lobo Antonio151617,De-la-Cámara Concepción151617,Lobo Elena151617,Bello Toyin18,Gureje Oye18,Ojagbemi Akin18,Lipton Richard B.1920,Katz Mindy J.19,Derby Carol A.1920,Kim Ki Woong212223,Han Ji Won2122,Oh Dae Jong24,Rolandi Elena2526,Davin Annalisa25,Rossi Michele25,Scarmeas Nikolaos2728,Yannakoulia Mary29,Dardiotis Themis3031,Hendrie Hugh C.3233,Gao Sujuan3334,Carrière Isabelle35,Ritchie Karen3536,Anstey Kaarin J.373839,Cherbuin Nicolas40,Xiao Shifu4142,Yue Ling4142,Li Wei4142,Guerchet Maëlenn M.43,Preux Pierre-Marie43,Aboyans Victor4344,Haan Mary N.45,Aiello Allison E.46,Ng Tze Pin4748,Nyunt Ma Shwe Zin47,Gao Qi47,Scazufca Marcia49,Sachdev Perminder S. S.1250

Affiliation:

1. Faculty of Medicine, University of New South Wales, Sydney, Australia

2. Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia

3. School of Psychology and Public Health, La Trobe University, Melbourne, Australia

4. The George Institute for Global Health, Sydney, Australia

5. School of Biomedical Sciences, University of New South Wales, Sydney, Australia

6. School of Public Health, Imperial College London, London, United Kingdom

7. School of Population Health, University of New South Wales, Sydney, Australia

8. Eastern Suburbs Older Persons’ Mental Health Service, Sydney, Australia

9. 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

10. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden

11. Psychiatry, Cognition and Old Age Psychiatry Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden

12. Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany

13. School of Psychology, Manawatu Campus, Massey University, Palmerston North, New Zealand

14. Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland

15. Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain

16. Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain

17. Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain

18. 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

19. Department of Neurology, Albert Einstein College of Medicine, Bronx, New York

20. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York

21. Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea

22. Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea

23. Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea

24. Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

25. Golgi Cenci Foundation, Abbiategrasso, Italy

26. Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy

27. First Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Athens, Greece

28. Department of Neurology, Columbia University, New York, New York

29. Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece

30. Department of Neurology, University Hospital of Larissa, Larissa, Greece

31. Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

32. Department of Psychiatry, Indiana University School of Medicine, Indianapolis

33. Indiana Alzheimer Disease Research Center, Indiana Alzheimer Disease Research Center, Indianapolis

34. Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis

35. Institut for Neurosciences of Montpellier, University Montpellier, National Institute for Health and Medical Research, Montpellier, France

36. Institut du Cerveau Trocadéro, Paris, France

37. University of New South Wales, School of Psychology, Sydney, Australia

38. Ageing Futures Institute, University of New South Wales, Sydney, Australia

39. Neuroscience Research Australia, Sydney, Australia

40. National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia

41. Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

42. Alzheimer’s Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China

43. National Institute for Health and Medical Research U1094, Institut de Recherche pour le Developpement UMR270, Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University Limoges, Centre Hospitalier et Universitaire Limoges, Limoges, France

44. Department of Cardiology, Dupuytren 2 University Hospital, Limoges, France

45. School of Medicine, University of California, San Francisco

46. Robert N. Butler Columbia Aging Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York

47. Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

48. Geriatric Education and Research Institute, Ministry of Health, Singapore, Singapore

49. Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil

50. Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia

Abstract

ImportanceThe utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested.ObjectivesTo 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.Data Source and Study SelectionLongitudinal, 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).Data Extraction and SynthesisParticipants 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.Main Outcomes and MeasuresThe 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.ResultsThe 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.Conclusions and RelevanceThis 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.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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