Blood Pressure, Antihypertensive Use, and Late-Life Alzheimer and Non-Alzheimer Dementia Risk
Matthew Lennon
(1)
,
Darren Lipnicki
(1)
,
Ben Chun Pan Lam
,
John Crawford
(1)
,
Aletta Schutte
(2, 3)
,
Ruth Peters
(2, 3, 4)
,
Therese Rydberg-Sterner
(5, 6)
,
Jenna Najar
(5)
,
Ingmar Skoog
(5)
,
Steffi Riedel-Heller
(7)
,
Susanne Röhr
(7, 8)
,
Alexander Pabst
(7)
,
Antonio Lobo
(9, 10)
,
Concepción De-La-Cámara
(9, 10)
,
Elena Lobo
(10, 9)
,
Richard Lipton
(11)
,
Mindy Katz
(11)
,
Carol Derby
(12, 13)
,
Ki Woong Kim
(14, 15)
,
Ji Won Han
(14)
,
Dae Jong Oh
,
Elena Rolandi
,
Annalisa Davin
,
Michele Rossi
,
Nikolaos Scarmeas
,
Mary Yannakoulia
,
Themis Dardiotis
,
Hugh Hendrie
,
Sujuan Gao
,
Isabelle Carriere
,
Karen Ritchie
,
Kaarin Anstey
,
Nicolas Cherbuin
,
Shifu Xiao
,
Ling Yue
,
Wei Li
,
Maëlenn Guerchet
(16)
,
Pierre-Marie Preux
(16)
,
Victor Aboyans
(16)
,
Mary Haan
,
Allison Aiello
,
Marcia Scazufca
,
Perminder Sachdev
1
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney
2 GIGH - The George Institute for Global Health [Sydney]
3 UNSW - University of New South Wales [Sydney]
4 Imperial College London
5 Sahlgrenska Academy at University of Gothenburg [Göteborg]
6 ARC - Aging Research Center [Karolinska Institutet]
7 ISAP - Occupational Health and Public Health
8 Massey University
9 IIS Aragón - Instituto de Investigación Sanitaria de Aragón [Zaragoza]
10 CIBER-SAM - Centro de Investigación Biomédica en Red Salud Mental [Madrid]
11 Saul B. Korey Department of Neurology
12 Albert Einstein College of Medicine [New York]
13 Department of Epidemiology and Population Health
14 SNUBH - Seoul National University Bundang Hospital
15 Seoul National University College of Medicine
16 EpiMaCT - Epidémiologie des Maladies Chroniques en zone tropicale
2 GIGH - The George Institute for Global Health [Sydney]
3 UNSW - University of New South Wales [Sydney]
4 Imperial College London
5 Sahlgrenska Academy at University of Gothenburg [Göteborg]
6 ARC - Aging Research Center [Karolinska Institutet]
7 ISAP - Occupational Health and Public Health
8 Massey University
9 IIS Aragón - Instituto de Investigación Sanitaria de Aragón [Zaragoza]
10 CIBER-SAM - Centro de Investigación Biomédica en Red Salud Mental [Madrid]
11 Saul B. Korey Department of Neurology
12 Albert Einstein College of Medicine [New York]
13 Department of Epidemiology and Population Health
14 SNUBH - Seoul National University Bundang Hospital
15 Seoul National University College of Medicine
16 EpiMaCT - Epidémiologie des Maladies Chroniques en zone tropicale
Matthew Lennon
- Fonction : Auteur
- PersonId : 1418607
- ORCID : 0000-0001-7097-3666
Ben Chun Pan Lam
- Fonction : Auteur
- PersonId : 1248988
- ORCID : 0000-0002-0879-5990
Ingmar Skoog
- Fonction : Auteur
- PersonId : 1418608
- ORCID : 0000-0002-9803-3438
Richard Lipton
- Fonction : Auteur
- PersonId : 1418609
- ORCID : 0000-0003-2652-2897
Ji Won Han
- Fonction : Auteur
- PersonId : 798924
- ORCID : 0000-0003-2418-4257
Dae Jong Oh
- Fonction : Auteur
Elena Rolandi
- Fonction : Auteur
Annalisa Davin
- Fonction : Auteur
Michele Rossi
- Fonction : Auteur
Nikolaos Scarmeas
- Fonction : Auteur
- PersonId : 761369
- ORCID : 0000-0001-6453-8908
Mary Yannakoulia
- Fonction : Auteur
- PersonId : 1305684
- ORCID : 0000-0003-2171-7337
Themis Dardiotis
- Fonction : Auteur
- PersonId : 1291720
- ORCID : 0000-0003-2957-641X
Hugh Hendrie
- Fonction : Auteur
Sujuan Gao
- Fonction : Auteur
Isabelle Carriere
- Fonction : Auteur
Karen Ritchie
- Fonction : Auteur
Kaarin Anstey
- Fonction : Auteur
- PersonId : 807421
- ORCID : 0000-0002-9706-9316
Nicolas Cherbuin
- Fonction : Auteur
- PersonId : 1418610
- ORCID : 0000-0001-6481-0748
Shifu Xiao
- Fonction : Auteur
Ling Yue
- Fonction : Auteur
Wei Li
- Fonction : Auteur
Mary Haan
- Fonction : Auteur
Allison Aiello
- Fonction : Auteur
Marcia Scazufca
- Fonction : Auteur
Perminder Sachdev
- Fonction : Auteur
- PersonId : 778032
- ORCID : 0000-0002-9595-3220
- IdRef : 076727041
Résumé
Background and objectives: Previous randomized controlled trials and longitudinal studies have indicated that ongoing antihypertensive use in late life reduces all-cause dementia risk, but the specific impact on Alzheimer dementia (AD) and non-AD risk remains unclear. This study investigates whether previous hypertension or antihypertensive use modifies AD or non-AD risk in late life and the ideal blood pressure (BP) for risk reduction in a diverse consortium of cohort studies.
Methods: This individual participant data meta-analysis included community-based longitudinal studies of aging from a preexisting consortium. The main outcomes were risk of developing AD and non-AD. The main exposures were hypertension history/antihypertensive use and baseline systolic BP/diastolic BP. Mixed-effects Cox proportional hazards models were used to assess risk and natural splines were applied to model the relationship between BP and the dementia outcomes. The main model controlled for age, age2, sex, education, ethnoracial group, and study cohort. Supplementary analyses included a fully adjusted model, an analysis restricting to those with >5 years of follow-up and models that examined the moderating effect of age, sex, and ethnoracial group.
Results: There were 31,250 participants from 14 nations in the analysis (41% male) with a mean baseline age of 72 (SD 7.5, range 60-110) years. Participants with untreated hypertension had a 36% (hazard ratio [HR] 1.36, 95% CI 1.01-1.83, p = 0.0406) and 42% (HR 1.42, 95% CI 1.08-1.87, p = 0.0135) increased risk of AD compared with "healthy controls" and those with treated hypertension, respectively. Compared with "healthy controls" both those with treated (HR 1.29, 95% CI 1.03-1.60, p = 0.0267) and untreated hypertension (HR 1.69, 95% CI 1.19-2.40, p = 0.0032) had greater non-AD risk, but there was no difference between the treated and untreated groups. Baseline diastolic BP had a significant U-shaped relationship (p = 0.0227) with non-AD risk in an analysis restricted to those with 5-year follow-up, but otherwise there was no significant relationship between baseline BP and either AD or non-AD risk.
Discussion: Antihypertensive use was associated with decreased AD but not non-AD risk throughout late life. This suggests that treating hypertension throughout late life continues to be crucial in AD risk mitigation. A single measure of BP was not associated with AD risk, but DBP may have a U-shaped relationship with non-AD risk over longer periods in late life.