Protective effect of controlled blood pressure on risk of dementia in low-risk, grade 1 hypertension

Abstract

High blood pressure (BP) increases the risk of dementia; however, few studies have reported on the risk of dementia in patients with low-risk, early-grade hypertension. We investigated the protective effect of controlled BP on risk of dementia in treated, low-risk, grade 1 hypertensive patients from the entire National Health Insurance Service National Health Examinee cohort.Methods: We selected grade 1 hypertension (140-159/ 90-99 mmHg) patients with low risk, diagnosed in 2005-2006. All patients (N ¼ 128 665) were classified into controlled (average BP < 140/90 mmHg during the followup) and uncontrolled (average BP ! 140/90 mmHg) BP groups and followed up until 2015. The risk of dementia was estimated using Cox proportional hazard model after adjustments for propensity score.Results: Average BP was 131/81 mmHg in the controlled group (N ¼ 49 408) and 144/87 mmHg in the uncontrolled group (N ¼ 99 257). Overall dementia incidence rates in controlled and uncontrolled groups were 4.9 and 8.1 per 1000 person-year, respectively. The controlled group showed lower risk of overall dementia, Alzheimer's disease, and vascular dementia than the uncontrolled group. The controlled group had a low risk of vascular dementia at all ages, especially in the younger group (age <60). The optimal BP level associated with the lowest risk of dementia was 130 to less than 140 mmHg for SBP and 70 to less than 80 mmHg for DBP. Conclusion:We concluded that among even low-risk and grade 1 hypertension patients, controlled BP significantly reduced the risk of dementia, including Alzheimer's disease and vascular dementia.

The use of angiotensin receptor blockers in dementia prevention

“…In addition, oligemia also downregulates important proteins for memory and brain plasticity, as well as upregulating APP, oligomerization of beta-amyloid, and phosphorylation of neuronal tau 6 . In this context, a recently published study shows that controlled BP in hypertensive patients is significantly associated with a lower risk of general dementia, vascular dementia, and AD; above all, the preventive effect of controlled BP for AD tends to be stronger in people over 60 years 14 . Therefore, corroborating our results, early antihypertensive treatment may be a reasonable tool in preventing dementia.…”

Leukoaraiosis: Epidemiology, Imaging, Risk Factors, and Management of Age-Related Cerebral White Matter Hyperintensities

“…322 It was also observed in the intensive BP treatment in patients with atrial fibrillation or depression. 323,324 On the contrary, more studies showed a significant association of aggressive BP-lowing with the reduced risk of dementia in elderly people, [325][326][327][328][329][330] including the community-dwelling persons aged 60 years or older, 331,332 hypertensive patients aged 50 years and older, 333 and those with hypertension up to 70 years of age. 322 While some studies do not support those influence of BP control on dementia.…”

Investigating the impact of hypertension with and without diabetes on Alzheimer's disease risk: A clinico‐pathological study

“…[HR] = 1.18) 3 and DM (HR = 1.65) 4 are each associated with an increased risk of AD, emphasizing their importance as targets for AD risk reduction. Although animal and human studies have consistently demonstrated that the treatment of hypertension reduces the risk of AD, [5][6][7] the evidence on the treatment of DM has been inconsistent.…”

“…Population‐based studies report that hypertension (hazard ratio [HR] = 1.18) 3 and DM (HR = 1.65) 4 are each associated with an increased risk of AD, emphasizing their importance as targets for AD risk reduction. Although animal and human studies have consistently demonstrated that the treatment of hypertension reduces the risk of AD, 5 , 6 , 7 the evidence on the treatment of DM has been inconsistent. A comprehensive meta‐analysis reported that nonspecific pharmacological treatment was not associated with a reduced risk of AD, insulin increased the risk of AD, and thiazolidinedione reduced the risk of AD.…”