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.

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.

Citation

Harrison, J. K., Van Der Wardt, V., Conroy, S. P., Stott, D. J., Dening, T., Gordon, A. L., Logan, P., Welsh, T. J., Taggar, J., Harwood, R., & Gladman, J. R. (2016). New horizons: the management of hypertension in people with dementia. Age and Ageing, 45(6), 740-746. https://doi.org/10.1093/ageing/afw155

• 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
• Contract Date: Nov 22, 2016