Antihypertensive treatment and risk of dementia: a retrospective database study

Wagner, G. A.; Icks, Andrea; Abholz, Heinz-Harald; Schröder-Bernhardi, D; Rathmann, Wolfgang; Kostev, Karel

doi:10.5414/cp201284

Cited by 29 publications

(41 citation statements)

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“…Nevertheless, recent experimental studies have suggested a protective effect [48]. Such an effect was also observed in a retrospective study of hypertensive patients treated with beta blockers [49] versus other drugs.…”

Section: Discussionmentioning

confidence: 80%

Ischemic aetiology, self-reported frailty, and gender with respect to cognitive impairment in chronic heart failure patients

González-Moneo

Sánchez‐Benavides

Verdú-Rotellar

et al. 2016

BMC Cardiovasc Disord

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BackgroundDecisive information on the parameters involved in cognitive impairment in patients with chronic heart failure is as yet lacking. Our aim was to determine the functional and psychosocial variables related with cognitive impairment using the mini-mental-state examination (MMSE) with age-and education-corrected scores.MethodsA cohort study of chronic heart failure patients included in an integrated multidisciplinary hospital/primary care program. The MMSE (corrected for age and education in the Spanish population) was administered at enrolment in the program. Analyses were performed in 525 patients. Demographic and clinical variables were collected. Comprehensive assessment included depression (Yesavage), family function (family APGAR), social network (Duke), dependence (Barthel Index), frailty (Barber), and comorbidities. Univariate and multivariate logistic regression were performed to determine the predictors of cognitive impairment.ResultsCognitive impairment affected 145 patients (27.6 %). Explanatory factors were gender (OR: 2.77 (1.75–4.39) p < 0.001), ischemic etiology (OR: 1.99 (1.25–3.17) p = 0.004), frailty (OR: 1.58 (0.99 to 2.50, p =0.050), albumin > 3.5 (OR: 0.59 (0.35–0.99) p = 0.048), and beta-blocker treatment (OR: 0.36 (0.17 to 0.76, p = 0.007)). No association was found between cognitive impairment and social support or family function.ConclusionThe observed prevalence of cognitive impairment using MMSE corrected scores was 27.6 %. A global approach in the management of these patients is needed, especially focusing on women and patients with frailty, low albumin levels, and ischemic aetiology heart failure.

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Section: Discussionmentioning

confidence: 80%

Ischemic aetiology, self-reported frailty, and gender with respect to cognitive impairment in chronic heart failure patients

González-Moneo

Sánchez‐Benavides

Verdú-Rotellar

et al. 2016

BMC Cardiovasc Disord

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“…Moreover, the belief that antihypertensive use reduces the risk dementia remains controversial, and a recent database study of antihypertensives found that while angiotensin converting enzyme inhibitor and beta-blocker use was inversely associated with incident dementia, calcium channel blocker use was positively associated with cognitive deficits (Wagner et al, 2012). …”

Section: Discussionmentioning

confidence: 99%

Age-related downregulation of the CaV3.1 T-type calcium channel as a mediator of amyloid beta production

Rice¹,

Berchtold²,

Cotman³

et al. 2014

Neurobiology of Aging

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Alzheimer's is a crippling neurodegenerative disease that largely affects aged individuals. Decades of research have highlighted age-related changes in calcium homeostasis that occur before and throughout the duration of the disease, and the contributions of such dysregulation to Alzheimer's disease pathogenesis. We report an age-related decrease in expression of the CaV3.1 T-type calcium channel at the level of messenger RNA and protein in both humans and mice that is exacerbated with the presence of Alzheimer's disease. Downregulating T-type calcium channels in N2a cells and the 3xTg-AD mouse model of Alzheimer's disease, by way of pharmacologic inhibition with NNC-55-0396, results in a rapid increase in amyloid beta production via reductions in non-amyloidogenic processing, whereas genetic over-expression of the channel in human embryonic kidney cells expressing amyloid precursor protein produces complementary effects. The age-related decline in CaV3.1 expression may therefore contribute to a pro-amyloidogenic environment in the aging brain and represents a novel opportunity to intervene in the course of Alzheimer's disease pathogenesis.

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“…17 Another retrospective, casecontrol study showed decreased odds of dementia with BB use during the preceding 3 years. 19 However, a small, 6-year follow-up study suggested worse cognitive decline among those with BB and ACE inhibitor use, and improved cognition with calcium channel blocker use in the elderly. 20 ARB treatment has also been linked to a reduced risk of Alzheimer disease among persons with a history of CVD, as compared with other cardiovascular drugs; however, this analysis used administrative data without validated outcome assessment and did not assess BB use specifically.…”

Section: Resultsmentioning

confidence: 99%

“…Limited data from observational studies suggest that BB use may slow cognitive decline 17,18 and possibly prevent dementia, 19 while others have found divergent results. 20 The current study examines the association between antihypertensive drug class and the risk of cognitive impairment in a large prospective cohort of elderly Japanese American men.…”

mentioning

confidence: 99%

Antihypertensive medication use and risk of cognitive impairment

et al. 2013

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Objective: To determine the associations between classes of antihypertensive medication use and the risk of cognitive impairment among elderly hypertensive men. Methods:The Honolulu-Asia Aging Study is a prospective, community-based cohort study of Japanese American men conducted in Honolulu, Hawaii. We examined 2,197 participants (mean age 77 years at cohort entry, 1991-1993, followed through September 2010) with hypertension and without dementia or cognitive impairment at baseline, who provided information on medication use. Cognitive function was assessed at 7 standardized examinations using the Cognitive Abilities Screening Instrument (CASI). Cognitive impairment was defined as a CASI score ,74.Results: A total of 854 men developed cognitive impairment (median follow-up, 5.8 years).b-Blocker use as the sole antihypertensive drug at baseline was consistently associated with a lower risk of cognitive impairment (incidence rate ratio [IRR] 0.69; 95% confidence interval [CI] 0.50-0.94), as compared with men not taking any antihypertensive medications, adjusting for multiple potential confounders. The use of diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or vasodilators alone was not significantly associated with cognitive impairment. Results were similar excluding those with cardiovascular disease or ,1 year of follow-up, and additionally adjusting for pulse pressure, heart rate, baseline and midlife systolic blood pressure, and midlife antihypertensive treatment (IRR 0.65; 95% CI 0.45-0.94). The association between b-blocker use and cognitive impairment was stronger among men with diabetes, men aged .75 years, and those with pulse pressure $70 mm Hg.Conclusions: b-blocker use is associated with a lower risk of developing cognitive impairment in elderly Japanese American men. Neurology â 2013;81:888-895 GLOSSARY ACE 5 angiotensin-converting enzyme; ARB 5 angiotensin receptor blocker; BB 5 b-blockers; BMI 5 body mass index; CASI 5 Cognitive Abilities Screening Instrument; CI 5 confidence interval; CVD 5 cardiovascular disease; DBP 5 diastolic blood pressure; HAAS 5 Honolulu-Asia Aging Study; HHP 5 Honolulu Heart Program; HR 5 heart rate; IRR 5 incidence rate ratio; LRT 5 likelihood ratio test; PP 5 pulse pressure; SBP 5 systolic blood pressure.Current treatments for dementia provide limited clinical benefit, 1 highlighting the need for preventive approaches to stem the epidemic estimated to affect more than 115 million people worldwide by 2050. 2 Hypertension, particularly elevated systolic blood pressure (SBP), has been associated with the development of cognitive impairment and dementia in late life, 3-8 as well as the neuropathologic lesions of dementia at autopsy. 6,9,10 Previous analyses from the HonoluluAsia Aging Study (HAAS) have estimated that 27% of dementia cases may be attributed to midlife SBP $120 mm Hg among inadequately treated men. 11 The effects of antihypertensive drug class in late life to prevent cognitive impairment, however, remain unclear. Data from ...

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Antihypertensive treatment and risk of dementia: a retrospective database study

Cited by 29 publications

References 0 publications

Ischemic aetiology, self-reported frailty, and gender with respect to cognitive impairment in chronic heart failure patients

Ischemic aetiology, self-reported frailty, and gender with respect to cognitive impairment in chronic heart failure patients

Age-related downregulation of the CaV3.1 T-type calcium channel as a mediator of amyloid beta production

Antihypertensive medication use and risk of cognitive impairment

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