Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis.

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dc.citation.issue9
dc.citation.volume6
dc.contributor.authorLennon MJ
dc.contributor.authorLam BCP
dc.contributor.authorLipnicki DM
dc.contributor.authorCrawford JD
dc.contributor.authorPeters R
dc.contributor.authorSchutte AE
dc.contributor.authorBrodaty H
dc.contributor.authorThalamuthu A
dc.contributor.authorRydberg-Sterner T
dc.contributor.authorNajar J
dc.contributor.authorSkoog I
dc.contributor.authorRiedel-Heller SG
dc.contributor.authorRöhr S
dc.contributor.authorPabst A
dc.contributor.authorLobo A
dc.contributor.authorDe-la-Cámara C
dc.contributor.authorLobo E
dc.contributor.authorBello T
dc.contributor.authorGureje O
dc.contributor.authorOjagbemi A
dc.contributor.authorLipton RB
dc.contributor.authorKatz MJ
dc.contributor.authorDerby CA
dc.contributor.authorKim KW
dc.contributor.authorHan JW
dc.contributor.authorOh DJ
dc.contributor.authorRolandi E
dc.contributor.authorDavin A
dc.contributor.authorRossi M
dc.contributor.authorScarmeas N
dc.contributor.authorYannakoulia M
dc.contributor.authorDardiotis T
dc.contributor.authorHendrie HC
dc.contributor.authorGao S
dc.contributor.authorCarrière I
dc.contributor.authorRitchie K
dc.contributor.authorAnstey KJ
dc.contributor.authorCherbuin N
dc.contributor.authorXiao S
dc.contributor.authorYue L
dc.contributor.authorLi W
dc.contributor.authorGuerchet MM
dc.contributor.authorPreux P-M
dc.contributor.authorAboyans V
dc.contributor.authorHaan MN
dc.contributor.authorAiello AE
dc.contributor.authorNg TP
dc.contributor.authorNyunt MSZ
dc.contributor.authorGao Q
dc.contributor.authorScazufca M
dc.contributor.authorSachdev PSS
dc.coverage.spatialUnited States
dc.date.accessioned2024-06-13T03:23:17Z
dc.date.available2024-06-13T03:23:17Z
dc.date.issued2023-09-12
dc.description.abstractIMPORTANCE: The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. OBJECTIVES: To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group. DATA SOURCE AND STUDY SELECTION: Longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece). DATA EXTRACTION AND SYNTHESIS: Participants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines. MAIN OUTCOMES AND MEASURES: The key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group. RESULTS: The analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P = .001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P = .02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P = .07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses. CONCLUSIONS AND RELEVANCE: This individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.
dc.description.confidentialfalse
dc.edition.editionSeptember 2023
dc.format.paginatione2333353-
dc.identifier.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/37698858
dc.identifier.citationLennon MJ, Lam BCP, Lipnicki DM, Crawford JD, Peters R, Schutte AE, Brodaty H, Thalamuthu A, Rydberg-Sterner T, Najar J, Skoog I, Riedel-Heller SG, Röhr S, Pabst A, Lobo A, De-la-Cámara C, Lobo E, Bello T, Gureje O, Ojagbemi A, Lipton RB, Katz MJ, Derby CA, Kim KW, Han JW, Oh DJ, Rolandi E, Davin A, Rossi M, Scarmeas N, Yannakoulia M, Dardiotis T, Hendrie HC, Gao S, Carrière I, Ritchie K, Anstey KJ, Cherbuin N, Xiao S, Yue L, Li W, Guerchet MM, Preux P-M, Aboyans V, Haan MN, Aiello AE, Ng TP, Nyunt MSZ, Gao Q, Scazufca M, Sachdev PSS. (2023). Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis.. JAMA Netw Open. 6. 9. (pp. e2333353-).
dc.identifier.doi10.1001/jamanetworkopen.2023.33353
dc.identifier.eissn2574-3805
dc.identifier.elements-typejournal-article
dc.identifier.issn2574-3805
dc.identifier.numbere2333353
dc.identifier.pii2809194
dc.identifier.urihttps://mro.massey.ac.nz/handle/10179/69838
dc.languageeng
dc.publisherAmerican Medical Association
dc.publisher.urihttps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809194
dc.relation.isPartOfJAMA Netw Open
dc.rightsCC BY 4.0
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectHumans
dc.subjectFemale
dc.subjectAged
dc.subjectMale
dc.subjectBlood Pressure
dc.subjectAntihypertensive Agents
dc.subjectLongitudinal Studies
dc.subjectHypertension
dc.subjectDementia
dc.titleUse of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis.
dc.typeJournal article
pubs.elements-id480556
pubs.organisational-groupOther
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