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Cited by 315Dementia and Cognitive Impairment ResearchBlood Pressure and Hypertension StudiesNeurological Disease Mechanisms and Treatments

Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia

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McGuinness, Bernadette, Todd, Stephen, Passmore, Peter, Bullock, Roger·2009·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004034.pub3PMC PMC7163274
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Abstract

BACKGROUND: This is an update of a previous review (McGuinness 2006).Hypertension and cognitive impairment are prevalent in older people. Hypertension is a direct risk factor for vascular dementia (VaD) and recent studies have suggested hypertension impacts upon prevalence of Alzheimer's disease (AD). Therefore does treatment of hypertension prevent cognitive decline? OBJECTIVES: To assess the effects of blood pressure lowering treatments for the prevention of dementia and cognitive decline in patients with hypertension but no history of cerebrovascular disease. SEARCH STRATEGY: The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources were searched on 13 February 2008 using the terms: hypertens$ OR anti-hypertens$. SELECTION CRITERIA: Randomized, double-blind, placebo controlled trials in which pharmacological or non-pharmacological interventions to lower blood pressure were given for at least six months. DATA COLLECTION AND ANALYSIS: Two independent reviewers assessed trial quality and extracted data. The following outcomes were assessed: incidence of dementia, cognitive change from baseline, blood pressure level, incidence and severity of side effects and quality of life. MAIN RESULTS: Four trials including 15,936 hypertensive subjects were identified. Average age was 75.4 years. Mean blood pressure at entry across the studies was 171/86 mmHg. The combined result of the four trials reporting incidence of dementia indicated no significant difference between treatment and placebo (236/7767 versus 259/7660, Odds Ratio (OR) = 0.89, 95% CI 0.74, 1.07) and there was considerable heterogeneity between the trials. The combined results from the three trials reporting change in Mini Mental State Examination (MMSE) did not indicate a benefit from treatment (Weighted Mean Difference (WMD) = 0.42, 95% CI 0.30, 0.53). Both systolic and diastolic blood pressure levels were reduced significantly in the three trials assessing this outcome (WMD = -10.22, 95% CI -10.78, -9.66 for systolic blood pressure, WMD = -4.28, 95% CI -4.58, -3.98 for diastolic blood pressure). Three trials reported adverse effects requiring discontinuation of treatment and the combined results indicated no significant difference (OR = 1.01, 95% CI 0.92, 1.11). When analysed separately, however, more patients on placebo in Syst Eur 1997 were likely to discontinue treatment due to side effects; the converse was true in SHEP 1991. Quality of life data could not be analysed in the four studies. Analysis of the included studies in this review was problematic as many of the control subjects received antihypertensive treatment because their blood pressures exceeded pre-set values. In most cases the study became a comparison between the study drug against a usual antihypertensive regimen. AUTHORS' CONCLUSIONS: There is no convincing evidence from the trials identified that blood pressure lowering in late-life prevents the development of dementia or cognitive impairment in hypertensive patients with no apparent prior cerebrovascular disease. There were significant problems identified with analysing the data, however, due to the number of patients lost to follow-up and the number of placebo patients who received active treatment. This introduced bias. More robust results may be obtained by conducting a meta-analysis using individual patient data.

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  • In type 2 diabetes, cognitive dysfunction independently predicts clinical outcomes but does not modify effects of BP lowering or glucose control on major cardiovascular events.

    “It was concluded that cognitive dysfunction is an independent predictor of clinical outcomes in patients with type 2 diabetes mellitus but does not modify the effects of blood pressure lowering or glucose control on the risk of major cardiovascular events.458”

    From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [458]

    The Background lists diabetes as a possible baseline risk factor, but the Discussion addresses whether blood-pressure lowering prevents cognitive decline or dementia in hypertensive patients without prior cerebrovascular disease. Searches for the claimed independent prediction and for glucose control and major cardiovascular events found no passage addressing those findings in patients with type 2 diabetes. (LLM, conf=0.76)

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Authors
McGuinness, B., Todd, S., Passmore, P., & Bullock, R.
Affiliations
  • Queen's University Belfast (GB)
  • Victoria Hospital (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2009-10-07
Issue
4
Pages
CD004034-CD004034
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd004034.pub3
PMC
PMC7163274
OpenAlex
W1903618807
Cited by
315
References
94
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 15 · 2020: 21 · 2019: 25 · 2018: 11 · 2017: 22 · 2016: 24 · 2015: 20 · 2014: 30 · 2013: 27 · 2012: 27
FWCI
3.53
Type
journal article
Language
en
Update notices
new_version (2021-05-24)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion)
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
hypertension, blood pressure reduction, antihypertensive drugs, dementia prevention, cognitive impairment, cognitive decline, vascular dementia, Alzheimer's disease, older adults, cerebrovascular disease, Mini-Mental State Examination, adverse effects, quality of life, systolic blood pressure, diastolic blood pressure, meta-analysis of trials, risk of bias assessment, publication bias
MeSH terms
Aged, Alzheimer Disease, Antihypertensive Agents, Cognition Disorders, Humans, Hypertension, Dementia, Vascular, Randomized Controlled Trials as Topic

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