Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis

Ruth Peters*, Sevil Yasar, Craig S Anderson, Shea Andrews, Riitta Antikainen, Hisatomi Arima, Nigel Beckett, Joanne C Beer, Anne Suzanne Bertens, Andrew Booth, Martin van Boxtel, Carol Brayne, Henry Brodaty, Michelle C Carlson, John Chalmers, Maria Corrada, Steven DeKosky, Carol Derby, Roger A Dixon, Françoise ForetteMary Ganguli, Willem A van Gool, Antonio Guaita, Ann M Hever, David B Hogan, Carol Jagger, Mindy Katz, Claudia Kawas, Patrick G Kehoe, Sirkka Keinanen-Kiukaanniemi, Rose Ann Kenny, Sebastian Köhler, Setor K Kunutsor, Jari Laukkanen, Colleen Maxwell, G Peggy McFall, Tessa van Middelaar, Eric P Moll van Charante, Tze-Pin Ng, Jean Peters, Iris Rawtaer, Edo Richard, Kenneth Rockwood, Lina Rydén, Perminder S Sachdev, Ingmar Skoog, Johan Skoog, Jan A Staessen, Blossom C M Stephan, Sylvain Sebert, Lutgarde Thijs, Stella Trompet, Phillip J Tully, Christophe Tzourio, Roberta Vaccaro, Eeva Vaaramo, Erin Walsh, Jane Warwick, Kaarin J Anstey

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)e267-e281
Number of pages15
Issue number3
Publication statusPublished - 21 Jan 2020


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