Abstract: TH-PO674
Blood Pressure Lowering for the Prevention of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Hughes, Diarmaid, Health Research Board Clinical Research Facility, Galway, Ireland
- Judge, Conor S., Health Research Board Clinical Research Facility, Galway, Ireland
- Murphy, Robert P., Health Research Board Clinical Research Facility, Galway, Ireland
- Costello, Maria, Health Research Board Clinical Research Facility, Galway, Ireland
- Canavan, Michelle, Health Research Board Clinical Research Facility, Galway, Ireland
- O'donnell, Martin, Health Research Board Clinical Research Facility, Galway, Ireland
Background
The benefit of blood pressure lowering for the prevention of cognitive impairment and dementia is unclear.
Methods
We performed a meta-analysis of large randomized controlled trials of antihypertensive therapy versus control that reported cognitive decline, cognitive impairment or dementia as an outcome measure. We determined whether antihypertensive therapy reduced the risk of cognitive impairment and/or dementia and explored whether its effect varied by baseline blood pressure, blood pressure difference between treatment groups and/or length of follow-up.
Results
Fourteen randomized controlled trials were eligible for inclusion. Antihypertensive therapy was associated with a statistically significant reduced risk of cognitive impairment (n=9) (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87-0.98) and dementia (n=12) (OR, 0.93; 95% CI, 0.88 to 0.99). Subgroup analysis of trials with a cumulative blood pressure difference above the median (6.5 mmHg) reduced the risk of dementia further (OR, 0.87; 95% CI, 0.80-0.96) (Figure 1). Antihypertensive therapy was not associated with a statistically significant reduction in the Mini Mental State Examination (MMSE) cognitive impairment score (n=5) (Mean change in MMSE, 0.44, 95% CI, -0.22–1.10) or a combination of the MMSE and the Trail Making Test (TMT) (n=7) (Standardised mean change, 0.10, 95% CI, -0.02–0.22). Meta-regression of baseline blood pressure, blood pressure difference or years of follow-up did not explain significant heterogeneity between studies for cognitive impairment or dementia risk.
Conclusion
Antihypertensive therapy reduces the risk of cognitive impairment and dementia.