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Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis

dc.rights.licenseopenen_US
dc.contributor.authorPETERS, Ruth
dc.contributor.authorXU, Ying
dc.contributor.authorFITZGERALD, Oisin
dc.contributor.authorAUNG, Htein Linn
dc.contributor.authorBECKETT, Nigel
dc.contributor.authorBULPITT, Christopher
dc.contributor.authorCHALMERS, John
dc.contributor.authorFORETTE, Francoise
dc.contributor.authorGONG, Jessica
dc.contributor.authorHARRIS, Katie
dc.contributor.authorHUMBURG, Peter
dc.contributor.authorMATTHEWS, Fiona E.
dc.contributor.authorSTAESSEN, Jan A.
dc.contributor.authorTHIJS, Lutgarde
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorTZOURIO, Christophe
dc.contributor.authorWARWICK, Jane
dc.contributor.authorWOODWARD, Mark
dc.contributor.authorANDERSON, Craig S.
dc.contributor.authorCOLLABORATION, For The Dementia RIsk REduCTion
dc.date.accessioned2022-12-09T08:38:53Z
dc.date.available2022-12-09T08:38:53Z
dc.date.issued2022-10-25
dc.identifier.issn1522-9645 (Electronic) 0195-668X (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/170525
dc.description.abstractEnObservational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients. A pooled individual participant data analysis of five seminal randomized double-blind placebo-controlled trials was undertaken to better define the effects of BP-lowering treatment for the prevention of dementia.Multilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia. The total sample included 28 008 individuals recruited from 20 countries. After a median follow-up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval: 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4 mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk.The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well-controlled hypertension and of antihypertensive treatment commenced earlier in the life-course to reduce the long-term risk of dementia.Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo.
dc.language.isoENen_US
dc.subject.enHypertension
dc.subject.enBlood pressure
dc.subject.enCognition
dc.subject.enDementia
dc.subject.enMeta-analysis
dc.subject.enClinical trials
dc.title.enBlood pressure lowering and prevention of dementia: an individual patient data meta-analysis
dc.typeArticle de revueen_US
dc.identifier.doi10.1093/eurheartj/ehac584en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed36282295en_US
bordeaux.journalEuropean Heart Journalen_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamHEALTHY_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03891236
hal.version1
hal.date.transferred2022-12-09T08:39:07Z
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
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