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By Melissa Kluczynski, MS
Several research studies have shown strong associations between high blood pressure and increased risks of dementia and cognitive decline especially among people aged 40-65 years. However, the findings have been mixed. Previous meta-analyses (large studies that combine data from individual research studies) of antihypertensive trials and dementia were at risk of bias in their results due to lack of uniformity in data handling. Also, previous studies combined data from both observational and clinical trials.
Therefore, people having difficulty managing their hypertension with non-pharmacological treatments (e.g., diet, exercise) may want to discuss starting antihypertensive medication with their healthcare provider to reduce their risk of dementia.
To overcome these limitations, a recent patient-level meta-analysis combined raw data from five different large double-blind (patients and clinicians are unaware of treatment) placebo-controlled (treatment is compared to an inactive substance such as a sugar pill) trials. Randomized controlled trials such as these provide the highest level of evidence in research. Data were combined for 28,008 patients from 20 countries across the five trials. Each trial recruited people in late-midlife or later life and each trial collected standardized blood pressure measures at baseline and regular intervals each year. Patients with pre-existing dementia or serious cognitive loss at baseline were excluded from each trial.
Patients were followed for a median of 4.3 years and 861 incident, or new, cases of dementia were identified. There were 403 (2.9%) and 458 (3.3%) people with incident dementia in the active and placebo groups, respectively. The results favored antihypertensive treatment which reduced the risk of dementia with a mean blood pressure lowering of 10/4 mmHg.
This study provides strong evidence in favor of antihypertensive treatment reducing risk of incident dementia compared to placebo. In other words, gaining control of blood pressure with medication can reduce the risk of dementia. Therefore, people having difficulty managing their hypertension with non-pharmacological treatments (e.g., diet, exercise) may want to discuss starting antihypertensive medication with their healthcare provider to reduce their risk of dementia.
Source: Ruth Peters, Ying Xu, Oisin Fitzgerald, Htein Linn Aung, Nigel Beckett, Christopher Bulpitt, John Chalmers, Francoise Forette, Jessica Gong, Katie Harris, Peter Humburg, Fiona E Matthews, Jan A Staessen, Lutgarde Thijs, Christophe Tzourio, Jane Warwick, Mark Woodward, Craig S Anderson, for the Dementia rIsk REduCTion (DIRECT) collaboration, Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis, European Heart Journal, 2022;, ehac584, https://doi.org/10.1093/eurheartj/ehac584
Melissa Kluczynski holds a Master of Science degree in Epidemiology from the University at Buffalo and she is currently working as a Research Associate in the Department of Cancer Prevention and Control at Roswell Park Comprehensive Cancer Center in Buffalo, NY. Her research interests include chronic disease prevention and women's health.
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