An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis

Ruth Peters; Sevil Yasar; Craig S. Anderson; Shea Andrews; Riitta Antikainen; Hisatomi Arima; Nigel Beckett; Joanne C. Beer; Anne Suzanne Bertens; Andrew Booth; Martin van Boxtel; Carol Brayne; Henry Brodaty; Michelle C. Carlson; John Chalmers; Maria Corrada; Steven DeKosky; Carol Derby; Roger A. Dixon; Françoise Forette; Mary Ganguli; Willem A. van Gool; Antonio Guaita; Ann M. Hever; David B. Hogan; Carol Jagger; Mindy Katz; Claudia Kawas; Patrick G. Kehoe; Sirkka Keinanen-Kiukaanniemi; Rose Ann Kenny; Sebastian Köhler; Setor K. Kunutsor; Jari Laukkanen; Colleen Maxwell; G. Peggy McFall; Tessa van Middelaar; Eric P. Moll van Charante; Tze-Pin Ng; Jean Peters; Iris Rawtaer; Edo Richard; Kenneth Rockwood; Lina Rydén; Perminder S. Sachdev; Ingmar Skoog; Johan Skoog; Jan A. Staessen; Blossom C. M. Stephan; Sylvain Sebert; Lutgarde Thijs; Stella Trompet; Phillip J. Tully; Christophe Tzourio; Roberta Vaccaro; Eeva Vaaramo; Erin Walsh; Jane Warwick; Kaarin J. Anstey

doi:https://doi.org/10.1212/WNL.0000000000008732

An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis

Ruth Peters, Sevil Yasar, Craig S. Anderson, Shea Andrews, Riitta Antikainen, Hisatomi Arima, Nigel Beckett, Joanne C. Beer, Anne Suzanne Bertens, Andrew Booth, Martin van Boxtel, Carol Brayne, Henry Brodaty, Michelle C. Carlson, John Chalmers, Maria Corrada, Steven DeKosky, Carol Derby, Roger A. Dixon, Françoise ForetteMary Ganguli, Willem A. van Gool, Antonio Guaita, Ann M. Hever, David B. Hogan, Carol Jagger, Mindy Katz, Claudia Kawas, Patrick G. Kehoe, Sirkka Keinanen-Kiukaanniemi, Rose Ann Kenny, Sebastian Köhler, Setor K. Kunutsor, Jari Laukkanen, Colleen Maxwell, G. Peggy McFall, Tessa van Middelaar, Eric P. Moll van Charante, Tze-Pin Ng, Jean Peters, Iris Rawtaer, Edo Richard, Kenneth Rockwood, Lina Rydén, Perminder S. Sachdev, Ingmar Skoog, Johan Skoog, Jan A. Staessen, Blossom C. M. Stephan, Sylvain Sebert, Lutgarde Thijs, Stella Trompet, Phillip J. Tully, Christophe Tzourio, Roberta Vaccaro, Eeva Vaaramo, Erin Walsh, Jane Warwick, Kaarin J. Anstey

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data. METHODS: To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data. RESULTS: Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age. CONCLUSION: Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals. CLINICAL TRIALS REGISTRATION: The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

Original language	English
Pages (from-to)	1-15
Number of pages	15
Journal	Neurology
Volume	94
Issue number	3
DOIs	https://doi.org/10.1212/WNL.0000000000008732
Publication status	Published - 21 Jan 2020

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Peters, R., Yasar, S., Anderson, C. S., Andrews, S., Antikainen, R., Arima, H., Beckett, N., Beer, J. C., Bertens, A. S., Booth, A., van Boxtel, M., Brayne, C., Brodaty, H., Carlson, M. C., Chalmers, J., Corrada, M., DeKosky, S., Derby, C., Dixon, R. A., ... Anstey, K. J. (2020). An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis. Neurology, 94(3), 1-15. https://doi.org/10.1212/WNL.0000000000008732

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title = "An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis",

abstract = "OBJECTIVE: High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data. METHODS: To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data. RESULTS: Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age. CONCLUSION: Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals. CLINICAL TRIALS REGISTRATION: The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.",

author = "Ruth Peters and Sevil Yasar and Anderson, {Craig S.} and Shea Andrews and Riitta Antikainen and Hisatomi Arima and Nigel Beckett and Beer, {Joanne C.} and Bertens, {Anne Suzanne} and Andrew Booth and {van Boxtel}, Martin and Carol Brayne and Henry Brodaty and Carlson, {Michelle C.} and John Chalmers and Maria Corrada and Steven DeKosky and Carol Derby and Dixon, {Roger A.} and Fran{\c c}oise Forette and Mary Ganguli and {van Gool}, {Willem A.} and Antonio Guaita and Hever, {Ann M.} and Hogan, {David B.} and Carol Jagger and Mindy Katz and Claudia Kawas and Kehoe, {Patrick G.} and Sirkka Keinanen-Kiukaanniemi and Kenny, {Rose Ann} and Sebastian K{\"o}hler and Kunutsor, {Setor K.} and Jari Laukkanen and Colleen Maxwell and McFall, {G. Peggy} and {van Middelaar}, Tessa and {Moll van Charante}, {Eric P.} and Tze-Pin Ng and Jean Peters and Iris Rawtaer and Edo Richard and Kenneth Rockwood and Lina Ryd{\'e}n and Sachdev, {Perminder S.} and Ingmar Skoog and Johan Skoog and Staessen, {Jan A.} and Stephan, {Blossom C. M.} and Sylvain Sebert and Lutgarde Thijs and Stella Trompet and Tully, {Phillip J.} and Christophe Tzourio and Roberta Vaccaro and Eeva Vaaramo and Erin Walsh and Jane Warwick and Anstey, {Kaarin J.}",

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pages = "1--15",

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Peters, R, Yasar, S, Anderson, CS, Andrews, S, Antikainen, R, Arima, H, Beckett, N, Beer, JC, Bertens, AS, Booth, A, van Boxtel, M, Brayne, C, Brodaty, H, Carlson, MC, Chalmers, J, Corrada, M, DeKosky, S, Derby, C, Dixon, RA, Forette, F, Ganguli, M, van Gool, WA, Guaita, A, Hever, AM, Hogan, DB, Jagger, C, Katz, M, Kawas, C, Kehoe, PG, Keinanen-Kiukaanniemi, S, Kenny, RA, Köhler, S, Kunutsor, SK, Laukkanen, J, Maxwell, C, McFall, GP, van Middelaar, T, Moll van Charante, EP, Ng, T-P, Peters, J, Rawtaer, I, Richard, E, Rockwood, K, Rydén, L, Sachdev, PS, Skoog, I, Skoog, J, Staessen, JA, Stephan, BCM, Sebert, S, Thijs, L, Trompet, S, Tully, PJ, Tzourio, C, Vaccaro, R, Vaaramo, E, Walsh, E, Warwick, J & Anstey, KJ 2020, 'An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis', Neurology, vol. 94, no. 3, pp. 1-15. https://doi.org/10.1212/WNL.0000000000008732

TY - JOUR

T1 - An investigation of antihypertensive class, dementia, and cognitive decline

T2 - A meta-analysis

AU - Peters, Ruth

AU - Yasar, Sevil

AU - Anderson, Craig S.

AU - Andrews, Shea

AU - Antikainen, Riitta

AU - Arima, Hisatomi

AU - Beckett, Nigel

AU - Beer, Joanne C.

AU - Bertens, Anne Suzanne

AU - Booth, Andrew

AU - van Boxtel, Martin

AU - Brayne, Carol

AU - Brodaty, Henry

AU - Carlson, Michelle C.

AU - Chalmers, John

AU - Corrada, Maria

AU - DeKosky, Steven

AU - Derby, Carol

AU - Dixon, Roger A.

AU - Forette, Françoise

AU - Ganguli, Mary

AU - van Gool, Willem A.

AU - Guaita, Antonio

AU - Hever, Ann M.

AU - Hogan, David B.

AU - Jagger, Carol

AU - Katz, Mindy

AU - Kawas, Claudia

AU - Kehoe, Patrick G.

AU - Keinanen-Kiukaanniemi, Sirkka

AU - Kenny, Rose Ann

AU - Köhler, Sebastian

AU - Kunutsor, Setor K.

AU - Laukkanen, Jari

AU - Maxwell, Colleen

AU - McFall, G. Peggy

AU - van Middelaar, Tessa

AU - Moll van Charante, Eric P.

AU - Ng, Tze-Pin

AU - Peters, Jean

AU - Rawtaer, Iris

AU - Richard, Edo

AU - Rockwood, Kenneth

AU - Rydén, Lina

AU - Sachdev, Perminder S.

AU - Skoog, Ingmar

AU - Skoog, Johan

AU - Staessen, Jan A.

AU - Stephan, Blossom C. M.

AU - Sebert, Sylvain

AU - Thijs, Lutgarde

AU - Trompet, Stella

AU - Tully, Phillip J.

AU - Tzourio, Christophe

AU - Vaccaro, Roberta

AU - Vaaramo, Eeva

AU - Walsh, Erin

AU - Warwick, Jane

AU - Anstey, Kaarin J.

PY - 2020/1/21

Y1 - 2020/1/21

N2 - OBJECTIVE: High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data. METHODS: To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data. RESULTS: Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age. CONCLUSION: Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals. CLINICAL TRIALS REGISTRATION: The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

AB - OBJECTIVE: High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data. METHODS: To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data. RESULTS: Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age. CONCLUSION: Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals. CLINICAL TRIALS REGISTRATION: The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.

UR - http://www.scopus.com/inward/record.url?scp=85078380895&partnerID=8YFLogxK

U2 - https://doi.org/10.1212/WNL.0000000000008732

DO - https://doi.org/10.1212/WNL.0000000000008732

M3 - Article

C2 - 31827004

SN - 0028-3878

VL - 94

SP - 1

EP - 15

JO - Neurology

JF - Neurology

IS - 3

ER -

An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis

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