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

Research output: Contribution to journalArticle (Academic Journal)peer-review

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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 languageEnglish
Number of pages16
JournalNeurology
Early online date11 Dec 2019
DOIs
Publication statusE-pub ahead of print - 11 Dec 2019

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