Cited by 898Dementia and Cognitive Impairment ResearchBlood Pressure and Hypertension StudiesNeurological Disease Mechanisms and Treatments

The Prevention of Dementia With Antihypertensive Treatment<subtitle>New Evidence From the Systolic Hypertension in Europe (Syst-Eur) Study</subtitle>

Open access
Forette, Françoise·2002·Archives of Internal Medicine

Abstract

BACKGROUND: After the double-blind, placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial ended in February 1997, randomized patients were offered active study medication for a further period of observation. OBJECTIVE: To refine the estimates of the long-term effects of antihypertensive therapy on the incidence of dementia. METHODS: Eligible patients had no dementia and were at least 60 years old. Their systolic blood pressure at entry was 160 to 219 mm Hg, with diastolic blood pressure below 95 mm Hg. Antihypertensive therapy was started immediately after randomization in the active treatment group, but only after termination of the double-blind trial in the control patients. Treatment consisted of nitrendipine (10-40 mg/d), with the possible addition of enalapril maleate (5-20 mg/d), hydrochlorothiazide (12.5-25 mg/d), or both add-on drugs. RESULTS: Median follow-up increased from 2.0 years in the double-blind trial to 3.9 years overall. The incidence of dementia doubled from 32 to 64 cases, 41 of whom had Alzheimer disease. Throughout follow-up, systolic/diastolic blood pressure was 7.0/3.2 mm Hg higher in the 1417 control patients than in the 1485 subjects randomized to active treatment. At the last examination, the blood pressure difference was still 4.2/2.9 mm Hg; 48.1%, 26.4%, and 11.4% of the control patients were taking nitrendipine, enalapril, and/or hydrochlorothiazide, whereas in the active treatment group these proportions were 70.2%, 35.4%, and 18.4%, respectively. Compared with the controls, long-term antihypertensive therapy reduced the risk of dementia by 55%, from 7.4 to 3.3 cases per 1000 patient-years (43 vs 21 cases, P<.001). After adjustment for sex, age, education, and entry blood pressure, the relative hazard rate associated with the use of nitrendipine was 0.38 (95% confidence interval, 0.23-0.64; P<.001). Treatment of 1000 patients for 5 years can prevent 20 cases of dementia (95% confidence interval, 7-33). CONCLUSION: The extended follow-up of Syst-Eur patients reinforces the evidence that blood pressure-lowering therapy initiated with a long-acting dihydropyridine protects against dementia in older patients with systolic hypertension.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/archinte.162.18.2046

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Rigaud AS, Seux ML, Staessen JA, Birkenha ¨ger WH, Forette F. Cerebral compli- cations of hypertension. J Hum Hypertens. 2000;14:605-616.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Washington, DC: American Psychiatric Asso- ciation; 1987.
  3. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. JAMA. 1963;185:914-919.
  4. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255- 3264.
  5. Ott A, Breteler MMB, van Harskamp F, Grobbee DE, Hofman A. The incidence of dementia in the Rotterdam study. In: Iqbal K, Winblad B, Nishimura T, Takeda K, Winieski H, eds. Alzheimer's Disease: Biology, Diagnosis and Therapeutics. New York, NY: John Wiley & Sons; 1997:1-10.
  6. Pahor M, Psaty BM, Alderman MH, et al. Health outcomes associated with cal- cium antagonists compared with other first-line antihypertensive therapies. Lan- cet. 2000;356:1949-1954.

Cited by

Sorted by citations

Authors
Forette, F.
Affiliations
Université Paris Cité (FR)
Corresponding author
Forette, Françoise
Venue
Archives of Internal Medicine
Published
2002-10-14
Volume
162
Issue
18
Pages
2046
ISSN
0003-9926 (ISSN-L)
OpenAlex
W2104565625
Cited by
898
References
58
Citations by year
2026: 6 · 2025: 17 · 2024: 16 · 2023: 15 · 2022: 18 · 2021: 28 · 2020: 58 · 2019: 28 · 2018: 45 · 2017: 31 · 2016: 45 · 2015: 26 · 2014: 38 · 2013: 45 · 2012: 46
FWCI
27.76
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • Lithuanian University of Health Sciences (submittedVersion)
Funders
  • Bayer
  • World Health Organization
  • Helsingin Yliopisto
  • Helsingin ja Uudenmaan Sairaanhoitopiiri
  • International Society of Hypertension
  • European Commission
  • University of Aberdeen
  • Institut National de la Santé et de la Recherche Médicale
  • Fonds National de la Recherche Luxembourg
  • Hebrew University of Jerusalem
  • Universidad de Granada
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
Keywords
dementia prevention, antihypertensive therapy, systolic hypertension, Syst-Eur trial, nitrendipine, enalapril, hydrochlorothiazide, Alzheimer's disease, older adults, cardiovascular risk factors, cognitive decline
MeSH terms
Aged, Antihypertensive Agents, Calcium Channel Blockers, Dementia, Double-Blind Method, Drug Therapy, Combination, Enalapril, Europe, Female, Follow-Up Studies, Humans, Hydrochlorothiazide, Hypertension, Male, Middle Aged, Nitrendipine, Time Factors, Incidence, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review