Antihypertensives may lower Dementia Risk in Late Life among patients with high BP

In a world where the elderly population is on the rise, the question of how to prevent dementia in later life has become increasingly important. A recent study has shed light on a possible answer, suggesting that antihypertensive medications may play a crucial role in reducing the risk of dementia. The findings challenge previous notions about hypertension and dementia, presenting a new perspective on cognitive health in older adults. 

The study results were published in the journal JAMA Network Open on September 12, 2023. 

The most common risk factor for dementia is hypertension. Midlife hypertension is linked to an increased incidence of both Alzheimer's dementia and dementia from other causes. As there is no supportive literature on the association between hypertension and dementia, researchers conducted a Longitudinal, population-based study to assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group.

The study, conducted as an individual patient data meta-analysis of longitudinal cohort studies, involved 34,519 community-dwelling older adults aged 60 to 110 years from 15 different countries. The participants were free of dementia at the outset of the study, with a mean age of 72.5 years and a mean follow-up period of 4.3 years. Participants were categorized into three groups based on hypertension and antihypertensive medication use. Baseline systolic BP (SBP) and diastolic BP (DBP) were considered continuous variables. The primary outcome was all-cause dementia, and sensitivity analyses explored potential moderating factors. Analyses employed Cox proportional hazards models to assess dementia risk, considering baseline blood pressure and other factors while adhering to reporting guidelines. 

Notable findings: 

• Individuals with untreated hypertension were found to be at a staggering 42% increased risk of developing dementia compared to their normotensive counterparts. 
• Individuals with untreated hypertension exhibited only a 26% increased risk of dementia compared to those with treated hypertension.
• Individuals with treated hypertension had no significantly increased dementia risk compared with healthy controls.
• The study found no significant association between baseline systolic BP (SBP) or diastolic BP (DBP) and dementia risk in any of the analyses. 

Moreover, the study explored potential moderating factors, such as age, sex, and racial group, but found no significant interactions with any of these variables. 

Thus, the study findings hold tremendous promise for public health, particularly in an era where dementia rates are on the rise. Effective strategies for dementia prevention are urgently needed, and this study points the way forward. For individuals aged 60 and above, the use of antihypertensive medications not only helps manage hypertension but may also serve as a powerful tool for reducing the risk of developing dementia. 

Further reading: Lennon MJ, Lam BCP, Lipnicki DM, et al. Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis. JAMA Netw Open. 2023;6(9):e2333353. doi: 10.1001/jamanetworkopen.2023.33353