Antihypertensive medication classes and the risk of dementia over a decade of follow-up

Abstract

Introduction: Use of angiotensin II (ATII)-stimulating antihypertensive medication (AHM), including angiotensin receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs), has been associated with lower dementia risk. Previous studies had relatively short followup periods. The aim of this study is to investigate if these effects are sustained over longer periods.Methods: This post hoc observational analysis was based on data from a dementia prevention trial (preDIVA and its observational extension), among Dutch community-dwelling older adults without prior diagnosis of dementia. Differential associations between AHM classes and incident dementia were studied after 7.0 and 10.4 years, based on the median follow-up durations of dementia cases and all participants.Results: After 7 years, use of ATII-stimulating antihypertensives [hazard ratio ¼ 0.68, 95% confidence interval (CI) ¼ 0.47-1.00], ARBs (hazard ratio ¼ 0.54, 95% CI ¼ 0.31-0.94) and dihydropyridine CCBs (hazard ratio ¼ 0.52, 95% CI ¼ 0.30-0.91) was associated with lower dementia risk. After 10.4 years, associations for ATIIstimulating antihypertensives, ARBs and dihydropyridine CCBs attenuated (hazard ratio ¼ 0.80, 95% CI ¼ 0.61-1.04; hazard ratio ¼ 0.75, 95% CI ¼ 0.53-1.07; hazard ratio ¼ 0.73, 95% CI ¼ 0.51-1.04 respectively), but still suggested lower dementia risk when compared with use of other AHM classes. Results could not be explained by competing risk of mortality. Conclusion:Our results suggest that use of ARBs, dihydropyridine CCBs and ATII-stimulating antihypertensives is associated with lower dementia risk over a decade, although associations attenuate over time. Apart from methodological aspects, differential effects of antihypertensive medication classes on incident dementia may in part be temporary, or decrease with ageing.

Nadciśnienie tętnicze i jego leczenie a prewencja zaburzeń funkcji poznawczych — rola połączenia walsartanu i amlodipiny. Przegląd dla lekarza praktyka

“…W opublikowanym na początku 2023 roku badaniu, obejmującym 1907 chorych z nadciśnieniem tętniczym, których obserwowano przez 7 lat, Schroevers i wsp. stwierdzili, że stosowanie ARB (HR = 0,54; 95% CI: 0,31-0,94) i dihydropirydynowych pochodnych CCB (HR = 0,52; 95% CI: 0,30-0,91) wiązało się z niższym ryzykiem wystąpienia demencji [52]. W badaniu, które przeprowadzili Feldman i wsp., obejmującym 15 664 chorych z nadciśnieniem tętniczym, których poddano 11-letniej obserwacji, wykazano natomiast, że amlodipina istotnie obniżała ryzyko wystąpienia demencji (HR = 0,61; 95% CI: 0,49-0,77), zwłaszcza u osób powyżej 60. roku życia [53].…”