Article Dans Une Revue JAMA Network Open Année : 2023

Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life

1 Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney
2 La Trobe University [Melbourne]
3 GIGH - The George Institute for Global Health [Sydney]
4 UNSW - University of New South Wales [Sydney]
5 Imperial College London
6 Sahlgrenska Academy at University of Gothenburg [Göteborg]
7 ARC - Aging Research Center [Karolinska Institutet]
8 Sahlgrenska University Hospital [Gothenburg]
9 Leipzig University / Universität Leipzig
10 Massey University
11 Trinity College Dublin
12 IIS Aragon - Aragón Health Research Institute - Instituto de Investigacion Sanitaria Aragon
13 CIBER-SAM - Centro de Investigación Biomédica en Red Salud Mental [Madrid]
14 Universidad de Zaragoza = University of Zaragoza [Saragossa University] = Université de Saragosse
15 University of Ibadan
16 Albert Einstein College of Medicine [New York]
17 SNUBH - Seoul National University Bundang Hospital
18 SNU - Seoul National University [Seoul]
19 Samsung Medical Center Sungkyunkwan University School of Medicine
20 Golgi Cenci Foundation
21 UNIPV - Università degli Studi di Pavia [Italia] = University of Pavia [Italy] = Université de Pavie [Italie]
22 NKUA - National and Kapodistrian University of Athens
23 HUA - Harokopio University of Athens
24 University Hospital of Larissa
25 Indiana University School of Medicine
26 INM - Institut des Neurosciences de Montpellier
27 ICM - Institut du Cerveau = Paris Brain Institute
28 NeuRA - Neuroscience Research Australia
29 ANU - Australian National University
30 Shanghai Jiao Tong University [Shanghai]
31 Shanghai Mental Health Center
32 EpiMaCT - Epidémiologie des Maladies Chroniques en zone tropicale
33 Service de cardiologie [CHU Limoges]
34 UC San Francisco - University of California [San Francisco]
35 Columbia Mailman School of Public Health
36 NUS - National University of Singapore
37 Yong Loo Lin School of Medicine [Singapore]
38 Ministry of Health [Singapore]
39 USP - Universidade de São Paulo = University of São Paulo
40 Prince of Wales Hospital
Oye Gureje
Mary Yannakoulia
Nicolas Cherbuin

Résumé

Importance : 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.

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hal-04571633 , version 1 (08-05-2024)

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Matthew J Lennon, Ben Chun Pan Lam, Darren M. Lipnicki, John D Crawford, Ruth Peters, et al.. Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life. JAMA Network Open, 2023, 6 (9), pp.e2333353. ⟨10.1001/jamanetworkopen.2023.33353⟩. ⟨hal-04571633⟩
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