Does use of antihypertensive drugs affect the incidence or progression of dementia? A systematic review.
ABSTRACT Hypertension appears to contribute to the development of dementia. Antihypertensive drugs may play an important role in altering the incidence or progression of dementia, particularly dementia of the vascular type; however, the neuroprotective effects of these agents in other types of dementia are not well characterized.
The main aims of this review were to examine the relationship between use of antihypertensive agents and the incidence and progression of Alzheimer's dementia (AD), vascular dementia (VaD), and unspecified dementia, and to consider whether these agents may be neuroprotective.
A search of the English-language literature (January 1996-August 2009) was conducted using PubMed, Ovid MEDLINE, EBSCO MEDLINE, and the Cochrane Database of Systematic Reviews for publications mentioning both antihypertensive drugs and dementia. A combination of searches was performed using the following terms: antihypertensive drugs, dementia, cognitive impairment, Alzheimer's dementia, vascular dementia, progression of cognitive impairment, severity of cognitive impairment, severity of dementia, prevalence, and incidence. Searches were also performed using the names of antihypertensive drug classes. The bibliographies of all retrieved articles were reviewed for additional relevant publications. The focus was on randomized controlled trials, cohort studies, and case-control studies, excluding studies in animals, patients aged <45 years, drugs other than antihypertensive agents, and the role in cognition of hormones, receptors, and enzymes.
Sixty-five potentially relevant articles were identified from the 536 publications retrieved by the literature search. After application of the exclusion criteria, 12 original studies were included in the review, all published between 1999 and 2008 and most involving patients with AD or VaD. The most frequently studied antihypertensive agents were calcium channel blockers (7 studies), diuretics (6 studies), and angiotensin-converting enzyme (ACE) inhibitors (6 studies). Overall, these medications appeared to be beneficial in dementia, but only ACE inhibitors and diuretics significantly reduced the risk for and progression of dementia in the majority of studies.
Antihypertensive medications-particularly ACE inhibitors and diuretics-may be helpful in reducing the risk for and progression of dementia. Large randomized clinical trials are warranted to further explore the relationship between antihypertensive drugs and dementia.
- SourceAvailable from: Fabricio Ferreira de Oliveira[Show abstract] [Hide abstract]
ABSTRACT: Background: Proper control of cerebrovascular risk is essential to prevent cognitive change in dementia due to Alzheimer's disease (AD). Objective: To investigate whether caregiver awareness to control cerebrovascular risk impacts the lifestyles of patients with AD. Methods: Consecutive outpatients with AD were assessed for demographic features, Clinical Dementia Rating scores, cerebrovascular risk, pharmacotherapy, dietary therapy and practice of physical activities. Patients and caregivers were inquired on awareness of the importance of measures to control cerebrovascular risk. Chi-square test was employed for statistics, significance at ρ < 0.05. Results: A total of 217 patients were included; whereas 149 caregivers (68.7%) were aware of the need to control cerebrovascular risk, only 11 patients (5.1%) simultaneously practiced physical activities and received pharmacological treatment and dietary therapy. Patients with hypertension and diabetes mellitus were more likely to receive dietary therapy (ρ = 0.007). Male patients were more engaged in physical activities (ρ = 0.018). Patients in earlier AD stages exercised (ρ = 0.0003) and received pharmacological treatment more often (ρ = 0.0072). Caregiver awareness of the need to control cerebrovascular risk was higher when patients had hypertension (ρ = 0.024) and/or hypercholesterolemia (ρ = 0.006), and influenced adherence to dietary therapy (ρ = 0.002) and to pharmacological treatment (ρ = 0.001). Discussion: Caregiver awareness of the need to control cerebrovascular risk has positive impacts for patients with AD. Oliveira FF, et al. / Rev Psiq Clín. Resumo Contexto: O risco cerebrovascular é fundamental na etiologia da demência da doença de Alzheimer (DA), sendo importante seu controle adequado. Objetivo: Investigar se o conhecimento dos cuidadores sobre o controle do risco cerebrovascular tem impacto sobre a saúde de pacientes com DA. Métodos: Pacientes consecutivos com DA foram avaliados quanto a dados demográficos, Clinical Dementia Rating, risco cerebrovascular, tratamento farmacológico, dietoterapia e prática de atividades físicas. Pacientes e cuidadores foram questionados quanto à importância de medidas para controle do risco cerebrovascular. Chi-quadrado foi empregado na análise estatística, significância com ρ < 0,05. Resultados: No total, 217 pacientes foram incluídos; enquanto 149 cuidadores (68,7%) conheciam a necessidade de controle do risco cerebrovascular, somente 11 pacientes (5,1%) simultaneamente praticavam exercícios e recebiam tratamento farmacológico e dietoterápico. Pacientes com hipertensão arterial e diabetes mellitus tinham maiores chances de receber dietotetapia (ρ = 0,007). Homens estavam mais engajados em atividades físicas (ρ = 0,018). Pacientes em estágios precoces da DA praticavam exercícios (ρ = 0,0003) e recebiam farmacoterapia mais frequentemente (ρ = 0,0072). O conhecimento dos cuidadores acerca do controle do risco cerebrovascular era maior quando os pacientes tinham hipertensão arterial (ρ = 0,024) e/ou dislipidemia (ρ = 0,006), e influenciou a adesão à dietoterapia (ρ = 0,002) e à farmacoterapia (ρ = 0,001). Conclusão: O conhecimento dos cuidadores acerca do risco cerebrovascular tem impactos positivos para pacientes com DA. Oliveira FF, et al. / Rev Psiq Clín. Palavras-chave: Doença de Alzheimer, demência, transtornos cerebrovasculares, fatores de risco, cuidadores.Revista de Psiquiatria Clínica 07/2014; 41(3):77-81. · 0.63 Impact Factor
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ABSTRACT: The range and magnitude of potential benefits and harms of antihypertensive treatment in people with dementia has not been previously established. A scoping review to identify potential domains of benefits and harms of antihypertensive therapy in people with dementia was undertaken. Systematic reviews of these domains were undertaken to examine the magnitude of the benefits or harms. Potential outcome domains identified in the 155 papers in the scoping review were cardiovascular events, falls, fractures and syncope, depression, orthostatic hypotension, behavioral disturbances, polypharmacy risks, kidney problems, sleep problems, interactions with cholinesterase inhibitors, and pain. The systematic reviews across these domains identified relatively few studies done in people with dementia, and no convincing evidence of safety, benefit, or harm across any of them. Given the lack of firm evidence of benefits or harm from antihypertensive therapy in people with dementia and the weak evidence for benefits in people over 80 years of age, the current presumption that the favorable evidence drawn from the treatment of nondemented people should be extrapolated to those with dementia is contentious. There is sufficient evidence to warrant particular caution and further research into treatment in this group of patients.Journal of the American Medical Directors Association 04/2014; · 5.30 Impact Factor
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ABSTRACT: Recent studies implied that angiotension receptor blockers (ARBs) not only have an antihypertensive effect but also have beneficial effects on dementia. The purpose of this study was to investigate the effects of ARBs on dementia and the subtypes. We conducted a population-based cohort study with data from the Taiwan National Health Insurance Research Database. A total of 24 531 matching pairs (1 : 1) of ARB-exposed and non-ARB-exposed patients were included. Each patient was individually tracked from 1997 to 2009 to identify incident cases of dementia (onset in 1999 or later). Cox proportional hazard regressions were employed to calculate the hazard ratios and 95% confidence intervals (CIs) for the association between ARBs and dementia, Alzheimer's disease and vascular dementia, conditional for matching pairs. There were 1322 cases (5.4%) of dementia in the ARB cohort and 2181 cases (8.9%) in the non-ARB cohort identified during the 11-year follow-up period. The multivariate-adjusted hazard ratios for dementia, Alzheimer's disease and vascular dementia were 0.54 (95% CI 0.51-0.59), 0.53 (95% CI 0.43-0.64) and 0.63 (95% CI 0.54-0.73) for patients with ARB treatments, respectively. In terms of cumulative dosage, patients with more than 1460 defined daily dose of ARBs had less risk than those patients with less than 1460 defined daily dose (hazard ratio 0.37 vs. 0.61; P < 0.05). These results suggest that ARB may be associated with a reduced risk of dementia in high vascular-risk individuals. Patients exposed to ARBs for higher cumulative doses experienced more protection from dementia and the subtypes.Journal of Hypertension 01/2014; · 4.22 Impact Factor