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Investigation of antihypertensive class, dementia, and cognitive decline
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(2020) Investigation of antihypertensive class, dementia, and cognitive decline. Neurology, 94 (3). e267-e281. doi:10.1212/WNL.0000000000008732
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WRAP-investigation-antihypertensive-class-dementia-cognitive-decline-Warwick-2020.pdf - Accepted Version - Requires a PDF viewer. Download (640Kb) | Preview |
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Official URL: http://dx.doi.org/10.1212/WNL.0000000000008732
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.
| Item Type: | Journal Article | ||||||||
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Journal or Publication Title: | Neurology | ||||||||
| Publisher: | Lippincott Williams & Wilkins | ||||||||
| ISSN: | 0028-3878 | ||||||||
| Official Date: | 21 January 2020 | ||||||||
| Dates: |
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| Date of first compliant deposit: | 22 October 2020 | ||||||||
| Volume: | 94 | ||||||||
| Number: | 3 | ||||||||
| Page Range: | e267-e281 | ||||||||
| DOI: | 10.1212/WNL.0000000000008732 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| Open Access Version: |
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