An investigation of antihypertensive class, dementia and cognitive decline.: A meta-analysis.

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

doi:10.1212/WNL.0000000000008732

An investigation of antihypertensive class, dementia and cognitive decline. A meta-analysis.

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

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Abstract

ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimising cognition. Our objective was to determine whether any particular class of antihypertensive was associated with a reduced risk of cognitive decline ordementia using comprehensive meta-analysis including reanalysis of original participant data.
MethodsTo identify suitable studies MEDLINE, Embase and PsycINFO® and pre-existing 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 incidentdementia 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.
ResultsOver 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, comparatorgroup and outcome. Limited data precluded meaningful analyses in those ≤65 years.
ConclusionsOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.

Original language	English
Number of pages	16
Journal	Neurology
Early online date	11 Dec 2019
DOIs	https://doi.org/10.1212/WNL.0000000000008732
Publication status	E-pub ahead of print - 11 Dec 2019

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Peters, R., Yasar, S., Anderson, C., Andrews , S., Antikainen, R., Beckett, N., Beer, J. C., Bertens, A. S., Booth, A., van Boxtel, M., Brayne, C. E. G., Brodaty, H., Carlson, M. C., Chalmers, J., Corrada, M., DeKosky, S., Derby, C., Dixon, R. A., Forette, F., ... Anstey, K. J. (2019). An investigation of antihypertensive class, dementia and cognitive decline. A meta-analysis. Neurology. https://doi.org/10.1212/WNL.0000000000008732

@article{900977fd835a4e139ac92a9b20bb747e,

title = "An investigation of antihypertensive class, dementia and cognitive decline.: A meta-analysis.",

abstract = "ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimising cognition. Our objective was to determine whether any particular class of antihypertensive was associated with a reduced risk of cognitive decline ordementia using comprehensive meta-analysis including reanalysis of original participant data.MethodsTo identify suitable studies MEDLINE, Embase and PsycINFO{\textregistered} and pre-existing 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 incidentdementia 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.ResultsOver 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, comparatorgroup and outcome. Limited data precluded meaningful analyses in those ≤65 years. ConclusionsOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.",

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

year = "2019",

month = dec,

day = "11",

doi = "10.1212/WNL.0000000000008732",

language = "English",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

}

Peters, R, Yasar, S, Anderson, C, Andrews , S, Antikainen, R, Beckett, N, Beer, JC, Bertens, AS, Booth, A, van Boxtel, M, Brayne, CEG, Brodaty, H, Carlson, MC, Chalmers, J, Corrada, M, DeKosky, S, Derby, C, Dixon, RA, Forette, F, Ganguli, M, van Gool, WA, Guaita, A, Hever, A, Hogan, DB, Jagger, C, Katz, M, Kawas, C, Kehoe, P, Keinanen-Kiukaanniemi, SM, Kenny, RA, Köhler, S, Kunutsor, S, Laukkanen, J, Maxwell, C, McFall, GP, van Middelaar, T, van Charante, EPM, Tze-Pin, N, Peters, J, Rawtaer, I, Richard, E, Rockwood, K, Rydén, L, Sachdev, PS, Skoog, I, Skoog, J, Staessen, JA, Stephan, BCM, Sebert, SP, Thijs, L, Trompet, S, Tully, PJ, Tzourio, C, Vaccaro, R, Varamo, E, Walsh, E, Warwick, J & Anstey, KJ 2019, 'An investigation of antihypertensive class, dementia and cognitive decline. A meta-analysis.', Neurology. https://doi.org/10.1212/WNL.0000000000008732

TY - JOUR

T1 - An investigation of antihypertensive class, dementia and cognitive decline.

T2 - A meta-analysis.

AU - Peters, Ruth

AU - Yasar, Sevil

AU - Anderson, Craig

AU - Andrews , Shea

AU - Antikainen, Riitta

AU - Beckett, Nigel

AU - Beer, Joanne C

AU - Bertens, Anne Suzanne

AU - Booth, Andrew

AU - van Boxtel, Martin

AU - Brayne, Carol E G

AU - Brodaty, Henry

AU - Carlson, Michelle C

AU - Chalmers, John

AU - Corrada, Maria

AU - DeKosky, Steven

AU - Derby, Carol

AU - Dixon, Roger A

AU - Forette, Francoise

AU - Ganguli, Mary

AU - van Gool, Willem A

AU - Guaita, Antonio

AU - Hever, Ann

AU - Hogan, David B

AU - Jagger, Carol

AU - Katz, Mindy

AU - Kawas, Claudia

AU - Kehoe, Patrick

AU - Keinanen-Kiukaanniemi, Sirkka M

AU - Kenny, Rose Ann

AU - Köhler, Sebastian

AU - Kunutsor, Setor

AU - Laukkanen, Jari

AU - Maxwell, Colleen

AU - McFall, G Peggy

AU - van Middelaar, Tessa

AU - van Charante, Eric P Moll

AU - Tze-Pin, Ng

AU - Peters, Jean

AU - Rawtaer, Iris

AU - Richard, Edo

AU - Rockwood, Kenneth

AU - Rydén, Lina

AU - Sachdev, Perminder S

AU - Skoog, Ingmar

AU - Skoog, Johan

AU - Staessen, Jan A

AU - Stephan, Blossom CM

AU - Sebert, Sylvain P

AU - Thijs, Lutgarde

AU - Trompet, Stella

AU - Tully, Phillip J

AU - Tzourio, Christophe

AU - Vaccaro, Roberta

AU - Varamo, Eeva

AU - Walsh, Erin

AU - Warwick, Jane

AU - Anstey, Kaarin J

PY - 2019/12/11

Y1 - 2019/12/11

N2 - ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimising cognition. Our objective was to determine whether any particular class of antihypertensive was associated with a reduced risk of cognitive decline ordementia using comprehensive meta-analysis including reanalysis of original participant data.MethodsTo identify suitable studies MEDLINE, Embase and PsycINFO® and pre-existing 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 incidentdementia 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.ResultsOver 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, comparatorgroup and outcome. Limited data precluded meaningful analyses in those ≤65 years. ConclusionsOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.

AB - ObjectiveHigh blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimising cognition. Our objective was to determine whether any particular class of antihypertensive was associated with a reduced risk of cognitive decline ordementia using comprehensive meta-analysis including reanalysis of original participant data.MethodsTo identify suitable studies MEDLINE, Embase and PsycINFO® and pre-existing 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 incidentdementia 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.ResultsOver 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, comparatorgroup and outcome. Limited data precluded meaningful analyses in those ≤65 years. ConclusionsOur findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.

U2 - 10.1212/WNL.0000000000008732

DO - 10.1212/WNL.0000000000008732

M3 - Article (Academic Journal)

C2 - 31827004

JO - Neurology

JF - Neurology

SN - 0028-3878

ER -

An investigation of antihypertensive class, dementia and cognitive decline. A meta-analysis.

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