Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study

Murray, Michael D.; Hendrie, Hugh C.; Lane, Kathleen A.; Zheng, Mengjie; Ambuehl, Roberta; Li, Shanshan; Unverzagt, Frederick W.; Callahan, Christopher M.; Gao, Sujuan

doi:10.1007/s11606-017-4281-x

Cited by 19 publications

(17 citation statements)

References 29 publications

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“…18 Seven studies diagnosed AD using NINCDS-ADRDA criteria. 24,26,28,29,32,34,36 Seventeen studies analyzed all-cause dementia, [17][18][19][20][21][22][23][25][26][27][31][32][33][35][36][37][38] and 5 AD only. 24,28e30,34 Follow-up ranged from 2.2 22,32 to 11 28 years (median¼4.3).…”

Section: Resultsmentioning

confidence: 99%

Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis

Brok

Dalen

Abdulrahman

et al. 2021

Journal of the American Medical Directors Association

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Objectives: To systematically review and synthesize the evidence on differential associations between antihypertensive medication (AHM) classes and the risk of incident dementia. Design: Systematic review and random effects frequentist network meta-analysis. Embase, MEDLINE, and the Cochrane library were searched from origin to December 2019. Setting and participants: Randomized controlled trials (RCTs) and prospective cohort studies that compared associations of different AHM classes with incident all-cause dementia and/or Alzheimer's disease over at least 1 year of follow-up. Measures: All cause dementia and/or Alzheimer's disease. Results: Fifteen observational studies and 7 RCTs were included. Data on AHM classes were available for 649,790 participants and dementia occurred in 19,600 (3.02%). Network meta-analysis showed that in observational studies, treatment with either calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs) was associated with lower dementia risks than treatment with other antihypertensives: CCBs vs angiotensin converting enzyme inhibitors (ACE inhibitors) (HR¼0.84, 95% CI 0.74-0.95), beta blockers (HR¼0.83, 95% CI 0.73-0.95) and diuretics (HR¼0.89, 95% CI 0.78-1.01) and ARBs vs ACE inhibitors (HR¼0.88, 95% CI 0.81-0.97), beta blockers (HR¼0.87, 95% CI 0.77-0.99), and diuretics (HR¼0.93, 95% CI 0.83-1.05). There were insufficient RCTs to create a robust network based on randomized data alone. Conclusions and Implications: Recommending CCBs or ARBs as preferred first-line antihypertensive treatment may significantly reduce the risk of dementia. If corroborated in a randomized setting, these findings reflect a low-cost and scalable opportunity to reduce dementia incidence worldwide.

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Section: Resultsmentioning

confidence: 99%

Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis

Brok

Dalen

Abdulrahman

et al. 2021

Journal of the American Medical Directors Association

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“…This may reflect protective effects of DiCCB beyond angiotensin II stimulation (e.g., stimulating angiogenesis), 6 , 15 or chance/bias from the study's relatively small number of DiCCB users, high number of comparisons, and observational design. Previous studies have found both lower 7 , 9 , 41 and higher 42 , 43 dementia risks for calcium channel blockers (CCBs) compared to ARBs and also lower 42 – 44 and higher 7 , 9 , 41 , 45 dementia risks for CCBs compared to diuretics. However, none of these were significant in direct comparison.…”

Section: Discussionmentioning

confidence: 99%

Association of Angiotensin II–Stimulating Antihypertensive Use and Dementia Risk

et al. 2021

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ObjectiveTo assess whether angiotensin-II stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin-1 receptor blockers) convey a lower risk of incident dementia compared to angiotensin-II inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, beta blockers, and non-dihydropyridine calcium channel blockers), in accordance with the “angiotensin hypothesis.”MethodsCox regression analyses of incident dementia (and/or mortality as competing risk) during 6–8 years of follow-up, in a population sample of 1909 non-demented community-dwelling individuals (54% women), aged 70–78 (mean: 74.5 ± 2.5) years.ResultsAfter a median of 6.7 years of follow-up, dementia status was available for 1,870 (98%) and mortality for 1,904 (>99%) participants. Dementia incidence was 5.6% (27/480) in angiotensin-II stimulating, 8.2% (59/721) in angiotensin-II inhibiting, and 6.9% (46/669) in both antihypertensive type users. Adjusted for dementia risk factors including blood pressure and medical history, angiotensin-II stimulating antihypertensive users had a 45% lower incident dementia rate (HR = 0.55, 95% CI = 0.34–0.89) without excess mortality (HR = 0.86, 95% CI = 0.64–1.16), and individuals using both types had a non-significant 20% lower dementia rate (HR = 0.80, 95% CI = 0.53–1.20) without excess mortality (HR = 0.97, 95% CI = 0.76–1.24), compared to angiotensin-II inhibiting antihypertensive users. Results were consistent for subgroups based on diabetes and stroke history, but may be specific for individuals without a history of cardiovascular disease.ConclusionsUsers of angiotensin-II stimulating antihypertensives had lower dementia rates compared to angiotensin-II inhibiting antihypertensive users, supporting the “angiotensin hypothesis.” Confounding by indication must be examined further, although sub-analyses suggest this did not influence results. If replicated, dementia prevention could become a compelling indication for older individuals receiving antihypertensive treatment.

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“…In general, blood pressure can be easily controlled by various medications. Numerous studies have revealed no differences between individuals using anti-hypertensive medications and those without hypertension [ 89 , 93 ]. It has also been observed that the control of blood pressure during the lifetime, especially during sleep, can significantly decrease the risk for development of dementia in later life [ 84 ].…”

Section: Other Established (Non-)modifiable Risk Factors and Possimentioning

confidence: 99%

“…We remind the reader that, for instance, midlife obesity is often associated with hypertension and diabetes mellitus. These three possibly modifiable risk factors can cause an accumulation of neurotoxic peptides and oxidative stress level changes in the brain that in time may result in cognitive impairment and dementia [ 78 , 81 , 89 ]. Similarly, the higher risk of dementia in the elderly individuals with various comorbid cardiometabolic diseases such as diabetes mellitus or stroke can be moderated by social engagement and physical activities [ 131 ].…”

Section: Future Possible Research Directions and Trends In The Trementioning

confidence: 99%

Association of Late Life Depression, (Non-) Modifiable Risk and Protective Factors with Dementia and Alzheimer’s Disease: Literature Review on Current Evidences, Preventive Interventions and Possible Future Trends in Prevention and Treatment of Dementia

Kuo

Stachiv

Nikolai

2020

IJERPH

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The number of people living with dementia and Alzheimer’s disease is growing rapidly, making dementia one of the biggest challenges for this century. Many studies have indicated that depression plays an important role in development of dementia, including Alzheimer’s disease; depression, especially, during the late life may either increase the risk of dementia or even being its prodromal stage. Despite a notably large number of carried observational studies and/or clinical trials, the association between the late life depression and dementia remains, due to the complexity of their relationship, still unclear. Moreover, during past two decades multiple other (non-)modifiable risk and possibly protective factors such as the hypertension, social engagement, obesity, level of education or physical (in)activity have been identified and their relationship with the risk for development of dementia and Alzheimer’s disease has been extensively studied. It has been proposed that to understand mechanisms of dementia and Alzheimer’s disease pathogeneses require their multifactorial nature represented by these multiple factors to be considered. In this review, we first summarize the recent literature findings on roles of the late life depression and the other known (non-)modifiable risk and possibly protective factors in development of dementia and Alzheimer’s disease. Then, we provide evidences supporting hypotheses that (i) depressive syndromes in late life may indicate the prodromal stage of dementia (Alzheimer’s disease) and, (ii) the interplay among the multiple (non-)modifiable risk and protective factors should be considered to gain a better understanding of dementia and Alzheimer’s disease pathogeneses. We also discuss the evidences of recently established interventions considered to prevent or delay the prodromes of dementia and provide the prospective future directions in prevention and treatment of dementia and Alzheimer’s disease using both the single-domain and multidomain interventions.

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Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study

Cited by 19 publications

References 29 publications

Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis

Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis

Association of Angiotensin II–Stimulating Antihypertensive Use and Dementia Risk

Association of Late Life Depression, (Non-) Modifiable Risk and Protective Factors with Dementia and Alzheimer’s Disease: Literature Review on Current Evidences, Preventive Interventions and Possible Future Trends in Prevention and Treatment of Dementia

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