Treatment of Hypertension in People With Dementia: A Multicenter Prospective Observational Cohort Study

Tomas J. Welsh*, Adam L. Gordon, John R.F. Gladman

*Corresponding author for this work

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

2 Citations (Scopus)
59 Downloads (Pure)

Abstract

Objectives
To describe the treatment of hypertension in people with dementia and collate evidence on adverse health events whilst on treatment.

Design
A multi-centre prospective observational cohort study.

Setting and Participants
People with documented diagnoses of hypertension and dementia were recruited through memory clinics and general practice from eight sites in the UK.

Methods
The cohort was recruited between July 2013 and October 2014. Participants underwent face-to-face, standardised assessment of blood pressure (BP), activities of daily living, cognitive function, and medication use. Follow up was by monthly telephone interview for 6 months to collate data on adverse health events.

Results
181 participants were recruited and 177 followed-up. 126 (70%) were female, mean age was 82 (SD6.3) years, median Mini Mental State Examination score 23 (IQR18-26) and mean BP 141/78 (SD22/12) mmHg. Antihypertensive drugs were prescribed in 157 (87%). Participants were prescribed a median of 1 (IQR1-2) antihypertensive medication. ACE-inhibitors and/or Angiotensin Receptor Blockers were the most frequently prescribed antihypertensives in 63% of participants. Target BP was achieved in 58% (95% CI49% - 64%). Increasing number of antihypertensives was not associated with lower systolic or diastolic BP, or with a higher proportion of patients attaining target BP. Participants had 214 falls, three had a fracture, three developed symptomatic heart failure, four had cerebrovascular events and eight died.

Conclusions and Implications
In this population of people with mild dementia, participants were treated with standard antihypertensive medications in a similar proportion to the general population, with a similar proportion achieving target BP. The rate of adverse health events was higher than in randomised controlled trials of antihypertensives and raises reservations about the assumptions underpinning antihypertensive treatment in people with dementia. These findings may help inform clinical decision making.
Original languageEnglish
Pages (from-to)1111-1115
Number of pages5
JournalJournal of the American Medical Directors Association
Volume20
Issue number9
Early online date17 May 2019
DOIs
Publication statusPublished - 1 Sep 2019

Keywords

  • Dementia
  • hypertension
  • antihypertensive agents

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