Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis

Rockwood, Kenneth; Peters, Ruth; Yasar, Sevil; Anderson, Craig S.; Andrews, Shea; Antikainen, Riitta; Arima, Hisatomi; Beckett, Nigel; Beer, Joanne C.; Bertens, Anne Suzanne; Booth, Andrew; van Boxtel, Martin; Brayne, Carol; Brodaty, Henry; Carlson, Michelle C.; Chalmers, John; Corrada, Maria; DeKosky, Steven; Derby, Carol; Dixon, Roger A.; Forette, Fran?oise; Ganguli, Mary; van Gool, Willem A.; Guaita, Antonio; Hever, Ann M.; Hogan, David B.; Jagger, Carol; Katz, Mindy; Kawas, Claudia; Kehoe, Patrick G.; Keinanen-Kiukaanniemi, Sirkka; Kenny, Rose Ann; K?hler, Sebastian; Kunutsor, Setor K.; Laukkanen, Jari; Maxwell, Colleen; McFall, G. Peggy; van Middelaar, Tessa; Moll van Charante, Eric P.; Ng, Tze-Pin; Peters, Jean; Rawtaer, Iris; Richard, Edo; Ryd?n, Lina; Sachdev, Perminder S.; Skoog, Ingmar; Skoog, Johan; Staessen, Jan A.; Stephan, Blossom C.M.; Sebert, Sylvain; Thijs, Lutgarde; Trompet, Stella; Tully, Phillip J.; Tzourio, Christophe; Vaccaro, Roberta; Vaaramo, Eeva; Walsh, Erin;...

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.

Citation

Rockwood, K., Peters, R., Yasar, S., Anderson, C. S., Andrews, S., Antikainen, R., Arima, H., Beckett, N., Beer, J. C., Bertens, A. S., Booth, A., van Boxtel, M., Brayne, C., Brodaty, H., Carlson, M. C., Chalmers, J., Corrada, M., DeKosky, S., Derby, C., Dixon, R. A., …Anstey, K. J. (2020). Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis. Neurology, 94(3), e267-e281. https://doi.org/10.1212/wnl.0000000000008732

• Journal Article Type: Article
• Acceptance Date: Jul 15, 2019
• Online Publication Date: Dec 11, 2019
• Publication Date: Jan 21, 2020
• Deposit Date: Mar 5, 2020
• Journal: Neurology
• Print ISSN: 0028-3878
• Electronic ISSN: 1526-632X
• Publisher: American Academy of Neurology
• Peer Reviewed: Peer Reviewed
• Volume: 94
• Issue: 3
• Pages: e267-e281
• DOI: https://doi.org/10.1212/wnl.0000000000008732
• Public URL: https://nottingham-repository.worktribe.com/output/4093530
• Publisher URL: https://n.neurology.org/content/94/3/e267