Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis
Abstract
OBJECTIVES: Prevention of cognitive decline and dementia with blood pressure lowering treatments has shown inconsistent results. We compared the effects of different classes of antihypertensive drugs on the incidence of dementia, and on cognitive function. METHODS: We conducted a systematic review and included 19 randomized trials (18 515 individuals) and 11 studies (831 674 individuals) analysing the effects of antihypertensive treatment on cognition and on the incidence of dementia, respectively, in hypertensive patients without prior cerebrovascular disorders. Network meta-analysis was used for the comparison of antihypertensive classes. RESULTS: Antihypertensive treatment, regardless of the drug class, had benefits on overall cognition [effect size 0.05, 95% confidence interval (CI) 0.02-0.07] and all cognitive functions except language. Antihypertensive treatment reduced the risk of all-cause dementia by 9%, with reference to the control group (hazard ratio 0.91, 95% CI 0.89-0.94), when randomized trials and observationnal studies were combined (n = 15). Result was not significant with randomized trials alone (n = 4). Angiotensin II receptor blockers (ARBs) had larger benefits than placebo on overall cognition (adjusted effect size 0.60 ± 0.18, P = 0.02). ARBs were more effective than β-blockers (0.67 ± 0.18, P = 0.01), diuretics (0.54 ± 0.19, P = 0.04) and angiotensin-converting enzyme inhibitors (0.47 ± 0.17, P = 0.04) in rank. The mean change in blood pressure did not differ significantly between the different antihypertensive drug classes. CONCLUSION: Our results support the notion that antihypertensive treatment has beneficial effects on cognitive decline and prevention of dementia, and indicate that these effects may differ between drug classes with ARBs possibly being the most effective.
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Hypertension causes over 40% of deaths in people with diabetes and is also a leading risk for fetal and maternal death in pregnancy, dementia, and renal failure (particularly in people of African ancestry) and can cause blindness.
“Hypertension causes over 40% of deaths in people with dia -betes 11 and is also a leading risk for fetal and maternal death in pregnancy, dementia, and renal failure (particularly in people of African ancestry) and can cause blindness.”
From São Paulo call to action for the prevention and control of high blood pressure: 2020 (2019) · cites this paper as [13]
Observational studies indicate that angiotensin II antagonists can protect the brain from hypertension-induced cognitive dysfunction.
“Neurovascular coupling and BBB are altered in essential hypertension (63), and observational studies indicate that ANGII antagonists can protect the brain from hypertension-induced cognitive dysfunction (64).”
From Perivascular macrophages mediate the neurovascular and cognitive dysfunction associated with hypertension (2016) · cites this paper as [64]
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- Authors
- Levi Marpillat, N., Macquin-Mavier, I., Tropeano, A.-I., Bachoud-Levi, A.-C., & Maison, P.
- Affiliations
- Assistance Publique – Hôpitaux de Paris (FR)
- Centre Hospitalier Universitaire Henri-Mondor (FR)
- Corresponding author
- Maison, Patrick
- Venue
- Journal of Hypertension
- Published
- 2013-06
- Volume
- 31
- Issue
- 6
- Pages
- 1073-1082
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2324980061
- Cited by
- 254
- References
- 46
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 7 · 2023: 18 · 2022: 15 · 2021: 30 · 2020: 24 · 2019: 24 · 2018: 24 · 2017: 15 · 2016: 31 · 2015: 25 · 2014: 14 · 2013: 1
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- 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
- antihypertensive drugs, cognitive decline, dementia incidence, hypertension, angiotensin receptor blockers, beta-blockers, diuretics, ACE inhibitors, blood pressure reduction, cognitive function, drug class comparison
- MeSH terms
- Animals, Antihypertensive Agents, Cognition, Cognition Disorders, Humans, Hypertension, Randomized Controlled Trials as Topic, Angiotensin Receptor Antagonists
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