Confirmed: Lowering blood pressure can reduce the risk of dementia

A robust meta-analysis provides evidence of class I in favor of antihypertensive treatment.

Knowledge

• Elderly patients with hypertension whose blood pressure-_(BP) is effectively treated with medication have a lower risk of developing dementia.
• Dementia prevention thus provides another reason for the treatment of hypertension, in addition to the positive effect on cardiovascular risk.

Why this matters

• Randomised controlled trials evaluating BP-lowering agents and the occurrence of dementia have led to different conclusions.
• Some data suggest in patients aged> 80  years to a U-shaped relationship between the   BP and dementia, which in turn has led to caution about aggressive BP lowering.
• Previous meta-analyses worked with the overall results, not individual patient data.
• In this study, raw data from individual patients from the ADVANCE, HYVET, PROGRESS, SHEP and SYST-EUR studies were pooled.
  • These are the only 5  Studies that included placebo control and investigated a dementia endpoint.
  • Ethically, a repetition of these studies is not justifiable, as it has now been convincingly demonstrated that lowering blood pressure improves cardiovascular outcomes.

• These are the only 5  Studies that included placebo control and investigated a dementia endpoint.
• Ethically, a repetition of these studies is not justifiable, as it has now been convincingly demonstrated that lowering blood pressure improves cardiovascular outcomes.

Study design

• Pooled meta-analysis of individual patient data from 5 randomized double-blind placebo-controlled studies in antihypertensive treatment (n = 28,008)
• Main result: emerging dementia
• Funding: None

Key results

• Medium Age: 69,1  Years
• Median follow-up: 4.3  years
• BP reduction with antihypertensive drugs resulted in:
  • a mean reduction in blood pressure of ~ 10/4 mmHg.
  • a lower risk of dementia: aOR: 0.87 (95 %-CI: 0.75–0.99).
• A greater reduction in BP was associated with a greater reduction in risk.
• Age and gender did not change the risk.

• a mean reduction in blood pressure of ~ 10/4 mmHg.
• a lower risk of dementia: aOR: 0.87 (95 %-CI: 0.75–0.99).

Limitations

• Treatment effect may have been underestimated by analysis.
• No data on dementia type

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