Controlling blood pressure even when older can prevent dementia in African Americans
INDIANAPOLIS – Controlling blood pressure with any of the commonly prescribed antihypertensive medications can prevent dementia in older African-Americans with hypertension according to a new study from Regenstrief Institute researchers.
African Americans are especially at risk of both hypertension and dementia. The new study provides substantial evidence of significant reduction of risk of onset of dementia for African American men and women age 65 and older with hypertension when they take any of a variety of drug classes for their high blood pressure. These medications include beta blockers, ACE inhibitors, calcium channel blocks and diuretics.
The large study looked at the effects of antihypertensive treatment on the risk of dementia over a period of up to 24 years in 1262 older African Americans with high blood pressure who were cognitively normal at the onset of the study.
"Other research has looked at midlife hypertension as risk factor for dementia," said study corresponding author Michael D. Murray, PharmD, MPH of the Regenstrief Institute's Center for Health Services Research and Purdue University College of Pharmacy. "We have found even if African Americans control blood pressure when they are 65 and older the risk of dementia can be reduced.
"And we also can now pass along the useful information that you don't need to take the expensive new drugs on market. Older generic medications will work just as well in lowering risk of dementia and are less expensive."
In a previous work, the Regenstrief Institute researchers reported that antihypertensive medications had a protective effect, reducing the odds of cognitive impairment in older African Americans. The new study investigated the effect of antihypertensive medications on cognitive impairment and dementia, determining that it is blood pressure reduction rather than the medications that lower risk of dementia.
The most recent National Health and Nutrition Examination Survey indicates that a quarter of patients with hypertension were not receiving an antihypertensive medication.
"Controlling blood pressure is important for lowering risk of heart attack, stroke and kidney disease," Dr. Murray said. "We can now add prevention of dementia to the list of benefits of good blood pressure control at all ages. Preventing dementia is critical; once you start the decline from cognitive impairment to mild and eventually severe dementia there is no known cure."
"Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study" is published in the April 2018 issue of Journal of General Internal Medicine.
Co-authors of the study, in addition to Dr. Murray, are Hugh C. Hendrie, DSc of the Regenstrief Institute and IU Center for Aging Research; Roberta Ambuehl, MS of the Regenstrief Institute; Kathleen A. Lane, MS, Mengjie Zheng, MS, Shanshan Li, PhD and Frederick W. Unverzagt, PhD of the IU School of Medicine; Christopher M. Callahan, MD of the Regenstrief Institute, IU Center for Aging Research and IU School of Medicine and senior author Sujuan Gao, PhD of the IU School of Medicine.
The study was funded by the National Institute on Aging (R01 AG0145350 and P30 AG10133), the Regenstrief Foundation and a Purdue University College of Pharmacy endowment in medication safety.
Cindy Fox Aisen