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

Journal article
Authors Ruth Peters
Sevil Yasar
Craig S Anderson
Shea Andrews
Riitta Antikainen
Hisatomi Arima
Nigel Beckett
Joanne C Beer
Anne Suzanne Bertens
Andrew Booth
Martin van Boxtel
Carol Brayne
Henry Brodaty
Michelle C Carlson
John Chalmers
Maria Corrada
Steven DeKosky
Carol Derby
Roger A Dixon
Françoise Forette
Mary Ganguli
Willem A van Gool
Antonio Guaita
Ann M Hever
David B Hogan
Carol Jagger
Mindy Katz
Claudia Kawas
Patrick G Kehoe
Sirkka Keinanen-Kiukaanniemi
Rose Ann Kenny
Sebastian Köhler
Setor K Kunutsor
Jari Laukkanen
Colleen Maxwell
G Peggy McFall
Tessa van Middelaar
Eric P Moll van Charante
Tze-Pin Ng
Jean Peters
Iris Rawtaer
Edo Richard
Kenneth Rockwood
Lina Rydén
Perminder S Sachdev
Ingmar Skoog
Johan Skoog
Jan A Staessen
Blossom C M Stephan
Sylvain Sebert
Lutgarde Thijs
Stella Trompet
Phillip J Tully
Christophe Tzourio
Roberta Vaccaro
Eeva Vaaramo
Erin Walsh
Jane Warwick
Kaarin J Anstey
Published in Neurology
ISSN 1526-632X
Publication year 2019
Published at Institute of Neuroscience and Physiology
Department of Psychology
Centre for Ageing and Health (Agecap)
Language en
Links dx.doi.org/10.1212/WNL.000000000000...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Cardiovascular medicine, Neurology

Abstract

High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting 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 incident dementia 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.Over 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, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

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