Abstract Body

Background:

Benefits of blood pressure (BP) lowering for the prevention of dementia or cognitive impairment (CI) are unclear. This review aimed to determine the association of BP lowering with dementia or CI.

Methods:

Randomized clinical trials (RCTs) that evaluated the association of BP lowering on cognitive outcomes were included. Random-effects meta-analysis models were used to report pooled treatment effects and Confidence Intervals. The primary outcome was dementia or CI. Secondary outcomes were cognitive decline and changes in cognitive test scores.

Results:

Fourteen RCTs were eligible for inclusion (96,158 participants).12 reported the incidence of dementia (or composite of dementia and CI [3 trials]) on follow-up and were included in the primary meta-analysis. 8 reported cognitive decline, and 8 reported changes in cognitive test scores. Mean (SD) age was 69 (5.4) years and 40,617 (42.2%) were women. Mean systolic baseline BP was 154(14.9)mmHg and mean diastolic BP was 83.3(9.9)mmHg. Mean duration of follow-up was 49.2 months.

BP lowering with antihypertensive agents compared with control was significantly associated with a reduced risk of dementia or CI (12 trials; 92,135 participants) (7.0% vs 7.5% of particpants; odds ratio[OR], 0.93 [95%CI, 0.88-0.98]; absolute risk reduction, 0.39% [95%CI, 0.09%-0.68%];I2 = 0.0%) and cognitive decline (8 trials) (20.2% vs 21.1% of participants; OR, 0.93 [95%CI, 0.88-0.99]; absolute risk reduction, 0.71% [95%CI, 0.19%-1.2%];I2 = 36.1%). BP lowering was not significantly associated with change in cognitive test scores.

Conclusions:

BP lowering with antihypertensive agents compared with control was significantly associated with a lower risk of incident dementia or CI