Can blood pressure drugs help reduce dementia risk?

A large study analising the medical data of thousands of people suggests that dementia incidence is lower among those who take blood pressure medication | via Medical News Today

blood-pressure-2310824_1920

A large new study has found a link between taking various kinds of blood pressure-lowering drugs and a lower risk of dementia among older adults, adding to the discussion around the link between cognitive decline and high blood pressure.

In their study the researchers analised data from 12,405 people, aged 60 or over, with dementia who attended one of 739 general practices in Germany as patients in 2013–2017. The team had access to all of these participants’ blood pressure values, as well as their medication records. This data was compared with those of 12,405 participants without dementia who had visited a general practice in the same time period.

The team found that those who took certain antihypertensive drugs — including beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers — seemed to have a lower risk of dementia.

Moreover, among those who took calcium channel blockers — which are another type of blood pressure drug — for a longer period of time, the incidence of dementia also decreased.

Full story at Medical News Today

Full reference: Bohlken, Jensa;  Jacob, Louisb; Kostev, Karelc | The Relationship Between the Use of Antihypertensive Drugs and the Incidence of Dementia in General Practices in Germany | Journal of Alzheimer’s Disease | Published: 20 May 2019

Clock drawing cognitive test should be done routinely in patients with high blood pressure

A clock drawing test for detecting cognitive dysfunction should be conducted routinely in patients with high blood pressure according to latest research | European Society of Cardiology | via ScienceDaily

Patients with high blood pressure who have impaired cognitive function are at increased risk of developing dementia within five years. Despite this known link, cognitive function is not routinely measured in patients with high blood pressure. Research presented at the European Society of Cardiology Congress 2018 suggests the clock drawing test should be adopted as a routine screening tool for cognitive decline in patients with high blood pressure.

clock

The Heart-Brain study evaluated the usefulness of the clock drawing test compared to the Mini-Mental State Examination (MMSE) to detect cognitive impairment.  For the clock drawing test, patients were given a piece of paper with a 10 cm diameter circle on it. They were asked to write the numbers of the clock in the correct position inside the circle and then draw hands on the clock indicating the time “twenty to four.”

The researchers found a higher prevalence of cognitive impairment with the clock drawing test (36%) compared to the MMSE (21%).

Full story at ScienceDaily

 

 

Study finds an association between systolic blood pressure in middle age and dementia

A study published in the latest edition of the European Heart Journal has found that individuals aged over 50 with systolic blood pressure  over 130 mmHg had a increased risk- they were one and a half times more likely to develop dementia- than peers with ‘ideal’ blood pressure. 

america-3265719_1920
Abstract

Aims

To examine associations of diastolic and systolic blood pressure (SBP) at age 50, 60, and 70 years with incidence of dementia, and whether cardiovascular disease (CVD) over the follow-up mediates this association.

Methods and results

Systolic and diastolic blood pressure were measured on 8639 persons (32.5% women) from the Whitehall II cohort study in 1985, 1991, 1997, and 2003. Incidence of dementia (n dementia/n total = 385/8639) was ascertained from electronic health records followed-up until 2017. Cubic splines using continuous blood pressure measures suggested SBP ≥130 mmHg at age 50 but not at age 60 or 70 was associated with increased risk of dementia, confirmed in Cox regression analyses adjusted for sociodemographic factors, health behaviours, and time varying chronic conditions. Diastolic blood pressure was not associated with dementia. Participants with longer exposure to hypertension (SBP ≥ 130 mmHg) between mean ages of 45 and 61 years had an increased risk of dementia compared to those with no or low exposure to hypertension. In multi-state models, SBP ≥ 130 mmHg at 50 years of age was associated with greater risk of dementia in those free of CVD over the follow-up.

Conclusion

Systolic blood pressure ≥130 mmHg at age 50, below the conventional ≥140 mmHg threshold used to define hypertension, is associated with increased risk of dementia; in these persons this excess risk is independent of CVD.

The full article is available to read at European Heart Journal

Full reference:
Abell, J.G., et al | 2018| Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension | European Heart Journal  ehy288| https://doi.org/10.1093/eurheartj/ehy288

See also:

OnMedica  Blood pressure below treatable threshold linked to heightened dementia risk

In the media:

BBC News Unfit in middle age:Are you doomed?

 

Interventions to prevent cognitive decline & dementia

Evidence supporting three interventions that might slow cognitive decline and the onset of dementia is encouraging but insufficient to justify a public health campaign focused on their adoption | ScienceDaily

24782-0309459591-450
Image source: NASEM

Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine.  Additional research is needed to further understand and gain confidence in their effectiveness, said the committee that conducted the study and wrote the report.

New horizons: the management of hypertension in people with dementia

Harrisson, J.K. et al. (2016) Age Ageing. 45(6). pp. 740-746

heart-1222517_960_720.jpg

The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful.

Read the full abstract here

Ambulatory blood pressure monitoring in older people with dementia: a systematic review of tolerability

Conroy, S.P. Age Ageing. Published online: April 7, 2016

Background: ambulatory blood pressure monitoring (ABPM) may be helpful for the management of hypertension, but little is known about its tolerability in people with dementia.

Objective: to review the published evidence to determine the tolerability of ABPM in people with dementia.

Methods: English language search conducted in MEDLINE and EMBASE, using ‘Ambulatory blood pressure’ AND ‘Dementia’ (and associated synonyms) from 1996 to March 2015. Inclusion criteria: people diagnosed with dementia AND in whom blood pressure was measured using ABPM. The initial search was undertaken using title and abstract reviews, with selected papers being agreed for inclusion by two reviewers. Potentially eligible papers were assessed, and high-quality papers were retained. Two reviewers agreed the abstracted data for analysis. Meta-analysis was used to combine results across studies.

Results: of the 221 screened abstracts, 13 studies (6%) met inclusion criteria, 5 had sufficient data and were of sufficient quality, involving 461 participants, most of whom had mild–moderate dementia. 77.7% (95% CI 62.2–93.2%) were able to tolerate ABPM; agreement with office BP was moderate to weak (two studies only—coefficients 0.3–0.38 for systolic blood pressure and 0.11–0.32 for diastolic blood pressure). One study compared home BP monitoring by a relative or ambulatory BP monitoring with office BP measures and found high agreement (κ 0.81). The little available evidence suggested increased levels of dementia being associated with reduced tolerability.

Conclusions: ABPM is well tolerated in people with mild–moderate dementia and provides some additional information over and above office BP alone. However, few studies have addressed ABPM in people with more severe dementia.

Read the abstract here