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Original Investigation
May 19, 2020

Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta-analysis

Author Affiliations
  • 1HRB Clinical Research Facility, NUI Galway and Saolta University Hospital Group, Galway, Ireland
  • 2Translational Medical Device Lab, NUI Galway, Galway, Ireland
  • 3Wellcome Trust-HRB, Irish Clinical Academic Training, Dublin, Ireland
  • 4Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
  • 5Population Health Research Institute, Hamilton, Canada
JAMA. 2020;323(19):1934-1944. doi:10.1001/jama.2020.4249
Key Points

Question  Is there an association between blood pressure lowering with antihypertensive therapy and the incidence of dementia or cognitive impairment?

Findings  In this meta-analysis that included 12 trials with 92 135 participants for the primary outcome measure, blood pressure lowering with antihypertensive agents, compared with control, was associated with the development of a composite dementia or cognitive impairment outcome in 7.0% vs 7.5% of patients over a mean trial follow-up of 4.1 years, a difference that was statistically significant.

Meaning  Lowering blood pressure may be associated with a lower risk of dementia or cognitive impairment.

Abstract

Importance  The benefit of blood pressure lowering for the prevention of dementia or cognitive impairment is unclear.

Objective  To determine the association of blood pressure lowering with dementia or cognitive impairment.

Data Sources and Study Selection  Search of PubMed, EMBASE, and CENTRAL for randomized clinical trials published from database inception through December 31, 2019, that evaluated the association of blood pressure lowering on cognitive outcomes. The control groups consisted of either placebo, alternative antihypertensive agents, or higher blood pressure targets.

Data Extraction and Synthesis  Data were screened and extracted independently by 2 authors. Random-effects meta-analysis models were used to report pooled treatment effects and CIs.

Main Outcomes and Measures  The primary outcome was dementia or cognitive impairment. The secondary outcomes were cognitive decline and changes in cognitive test scores.

Results  Fourteen randomized clinical trials were eligible for inclusion (96 158 participants), of which 12 reported the incidence of dementia (or composite of dementia and cognitive impairment [3 trials]) on follow-up and were included in the primary meta-analysis, 8 reported cognitive decline, and 8 reported changes in cognitive test scores. The mean (SD) age of trial participants was 69 (5.4) years and 40 617 (42.2%) were women. The mean systolic baseline blood pressure was 154 (14.9) mm Hg and the mean diastolic blood pressure was 83.3 (9.9) mm Hg. The mean duration of follow-up was 49.2 months. Blood pressure lowering with antihypertensive agents compared with control was significantly associated with a reduced risk of dementia or cognitive impairment (12 trials; 92 135 participants) (7.0% vs 7.5% of patients over a mean trial follow-up of 4.1 years; odds ratio [OR], 0.93 [95% CI, 0.88-0.98]; absolute risk reduction, 0.39% [95% CI, 0.09%-0.68%]; I2 = 0.0%) and cognitive decline (8 trials) (20.2% vs 21.1% of participants over a mean trial follow-up of 4.1 years; OR, 0.93 [95% CI, 0.88-0.99]; absolute risk reduction, 0.71% [95% CI, 0.19%-1.2%]; I2 = 36.1%). Blood pressure lowering was not significantly associated with a change in cognitive test scores.

Conclusions and Relevance  In this meta-analysis of randomized clinical trials, blood pressure lowering with antihypertensive agents compared with control was significantly associated with a lower risk of incident dementia or cognitive impairment.

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