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Antihypertensive Medication Classes and the Risk of Dementia: A Systematic Review and Network Meta-Analysis.
- Source :
-
Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2021 Jul; Vol. 22 (7), pp. 1386-1395.e15. Date of Electronic Publication: 2021 Jan 16. - Publication Year :
- 2021
-
Abstract
- Objectives: To systematically review and synthesize the evidence on differential associations between antihypertensive medication (AHM) classes and the risk of incident dementia.<br />Design: Systematic review and random effects frequentist network meta-analysis. Embase, MEDLINE, and the Cochrane library were searched from origin to December 2019.<br />Setting and Participants: Randomized controlled trials (RCTs) and prospective cohort studies that compared associations of different AHM classes with incident all-cause dementia and/or Alzheimer's disease over at least 1 year of follow-up.<br />Measures: All cause dementia and/or Alzheimer's disease.<br />Results: Fifteen observational studies and 7 RCTs were included. Data on AHM classes were available for 649,790 participants and dementia occurred in 19,600 (3.02%). Network meta-analysis showed that in observational studies, treatment with either calcium channel blockers (CCBs) or angiotensin II receptor blockers (ARBs) was associated with lower dementia risks than treatment with other antihypertensives: CCBs vs angiotensin converting enzyme inhibitors (ACE inhibitors) (HR=0.84, 95% CI 0.74-0.95), beta blockers (HR=0.83, 95% CI 0.73-0.95) and diuretics (HR=0.89, 95% CI 0.78-1.01) and ARBs vs ACE inhibitors (HR=0.88, 95% CI 0.81-0.97), beta blockers (HR=0.87, 95% CI 0.77-0.99), and diuretics (HR=0.93, 95% CI 0.83-1.05). There were insufficient RCTs to create a robust network based on randomized data alone.<br />Conclusions and Implications: Recommending CCBs or ARBs as preferred first-line antihypertensive treatment may significantly reduce the risk of dementia. If corroborated in a randomized setting, these findings reflect a low-cost and scalable opportunity to reduce dementia incidence worldwide.<br /> (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Angiotensin Receptor Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Antihypertensive Agents adverse effects
Calcium Channel Blockers adverse effects
Humans
Network Meta-Analysis
Dementia drug therapy
Dementia epidemiology
Hypertension drug therapy
Hypertension epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1538-9375
- Volume :
- 22
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of the American Medical Directors Association
- Publication Type :
- Academic Journal
- Accession number :
- 33460618
- Full Text :
- https://doi.org/10.1016/j.jamda.2020.12.019