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New horizons: the management of hypertension in people with dementia

Harrison, Jennifer K.; Van Der Wardt, Veronika; Conroy, Simon P.; Stott, David J.; Dening, Tom; Gordon, Adam L.; Logan, Pip; Welsh, Tomas J.; Taggar, Jaspal; Harwood, Rowan; Gladman, John R.F.

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Authors

Jennifer K. Harrison

Veronika Van Der Wardt

Simon P. Conroy

David J. Stott

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TOM DENING TOM.DENING@NOTTINGHAM.AC.UK
Clinical Professor in Dementia Research

ADAM GORDON Adam.Gordon@nottingham.ac.uk
Professor of The Care of Older People

PIP LOGAN pip.logan@nottingham.ac.uk
Professor of Rehabilitation Research

Tomas J. Welsh

Dr JASPAL TAGGAR JASPAL.TAGGAR@NOTTINGHAM.AC.UK
Professor of Primary Care and Medical Education

John R.F. Gladman



Abstract

The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful. Robust evidence is scant, trials of antihypertensive medications have generally excluded those with dementia. Observational data show changes in risk association over the life course, with high BP being a risk factor for cognitive decline in mid-life, while low BP is predictive in later life. It is therefore possible that excessive BP lowering in older people with dementia might harm cognition. From the existing literature, there is no direct evidence of benefit or harm from treating hypertension in people with dementia. So what practical steps can the clinician take? Assess capacity, establish patient preferences when making treatment decisions, use ambulatory monitoring to thoroughly assess BP, individualise and consider deprescribing where side effects (e.g. hypotension) outweigh the benefits. Future research might include pragmatic randomised trials of targeted deprescribing, which include patient-centred outcome measures to help support decision-making and studies to address mechanistic uncertainties.

Journal Article Type Article
Acceptance Date Aug 3, 2016
Online Publication Date Nov 2, 2016
Publication Date Nov 1, 2016
Deposit Date Nov 22, 2016
Publicly Available Date Nov 22, 2016
Journal Age and Ageing
Print ISSN 0002-0729
Electronic ISSN 1468-2834
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 45
Issue 6
Pages 740-746
DOI https://doi.org/10.1093/ageing/afw155
Keywords older people; hypertension; dementia; deprescribing; decision-making; individualise
Public URL https://nottingham-repository.worktribe.com/output/819810
Publisher URL http://ageing.oxfordjournals.org/content/45/6/740.abstract
Additional Information This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record: Jennifer Kirsty Harrison, Veronika Van Der Wardt, Simon Paul Conroy, David J. Stott, Tom Dening, Adam Lee Gordon, Pip Logan, Tomas James Welsh, Jaspal Taggar, Rowan Harwood, and John R. F. Gladman
New horizons: the management of hypertension in people with dementia
Age Ageing 2016 45: 740-746. is available online at: http://ageing.oxfordjournals.org/content/45/6/740.abstract. doi:10.1093/ageing/afw155