Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study

Michael D. Murray, Hugh C. Hendrie, Kathleen A. Lane, Mengjie Zheng, Roberta Ambuehl, Shanshan Li, Frederick W. Unverzagt, Christopher M. Callahan, Sujuan Gao

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: African Americans are especially at risk of hypertension and dementia. Antihypertensive medications reduce the risk of cardiovascular events, but may also reduce the risk of dementia. Objective: To assess the longitudinal effects of antihypertensive medications and blood pressure on the onset of incident dementia in a cohort of African Americans. Design: Prospective cohort. Participants: 1236 community-dwelling patients from an inner-city public health care system, aged 65 years and older, with a history of hypertension but no history of dementia, and who had at least three primary care visits and a prescription filled for any medication. Main Measures: Blood pressure was the average of three seated measurements. Dementia was diagnosed using a two-stage design, with a screening evaluation every 2 to 3 years followed by a comprehensive in-home clinical evaluation for those with a positive screen. Laboratory, inpatient and outpatient encounter data, coded diagnoses and procedures, and medication records were derived from a health information exchange. Key Results: Of the 1236 hypertensive participants without dementia at baseline, 114 (9%) developed incident dementia during follow-up. Individuals prescribed any antihypertensive medication (n = 816) were found to have a significantly reduced risk of dementia (HR = 0.57, 95% CI 0.37–0.88, p = 0.0114) compared to untreated hypertensive participants (n = 420). When this analysis was repeated including a variable indicating suboptimally treated blood pressure (> 140 mmHg systolic or >90 mmHg diastolic), the effect of antihypertensive medication was no longer statistically significant (HR = 0.65, 95% CI 0.32–1.30, p = 0.2217). Conclusions: Control of blood pressure in older adult African American patients with hypertension is a key intervention for preventing dementia, with similar benefits from most of the commonly available antihypertensive medications.

Original languageEnglish (US)
Pages (from-to)455-462
Number of pages8
JournalJournal of general internal medicine
Volume33
Issue number4
DOIs
StatePublished - Apr 1 2018

Keywords

  • African Americans
  • antihypertensives
  • dementia
  • hypertension
  • prospective cohort

ASJC Scopus subject areas

  • Internal Medicine

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