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Treatment of Hypertension in People With Dementia: A Multicenter Prospective Observational Cohort Study
Tomas J Welsh1, Adam L Gordon2, John R F Gladman3
1Research Institute for the Care of Older People (RICE), Bath, Somerset, United Kingdom; Royal United Hospital Bath NHS Foundation Trust, Bath, Somerset, United Kingdom; University of Bristol, Bristol, United Kingdom.
Insights
Hypertension treatment in dementia patients showed similar BP control to the general population but with a higher rate of adverse events, questioning current treatment assumptions.
Area of Science:
- Gerontology
- Cardiology
- Neurology
Background:
- Hypertension is common in individuals with dementia.
- Optimal blood pressure management in this population remains a clinical challenge.
- Evidence on adverse health events associated with antihypertensive treatment in dementia patients is limited.
Purpose of the Study:
- To describe the current treatment of hypertension in people diagnosed with dementia.
- To gather evidence on adverse health events experienced by these patients while on antihypertensive medication.
Main Methods:
- A multicenter prospective observational cohort study involving 181 participants with hypertension and dementia from 8 UK sites.
- Standardized assessments of blood pressure, daily living activities, cognitive function, and medication use.
- Six-month follow-up via telephone interviews to record adverse health events.
Main Results:
- 87% of participants were prescribed antihypertensive drugs, with 58% achieving target blood pressure.
- Commonly prescribed antihypertensives included ACE inhibitors and/or ARBs.
- Adverse events included 214 falls, 3 fractures, 3 heart failures, 4 cerebrovascular events, and 8 deaths.
Conclusions:
- People with mild dementia received standard antihypertensive treatment, with similar BP control to the general population.
- The observed rate of adverse health events was higher than reported in randomized controlled trials.
- Findings suggest a need to re-evaluate the assumptions underlying antihypertensive treatment strategies in individuals with dementia.
Objectives:
To describe the treatment of hypertension in people with dementia and collate evidence on adverse health events whilst on treatment.
Design:
A multicenter prospective observational cohort study.
Setting And Participants:
People with documented diagnoses of hypertension and dementia were recruited through memory clinics and general practice from 8 sites in the United Kingdom.
Methods:
The cohort was recruited between July 2013 and October 2014. Participants underwent face-to-face, standardized assessment of blood pressure (BP), activities of daily living, cognitive function, and medication use. Follow-up was by monthly telephone interview for 6 months to collate data on adverse health events.
Results:
181 participants were recruited and 177 followed up; 126 (70%) were female, mean age was 82 [standard deviation (SD) 6.3] years, median Mini-Mental State Examination score was 23 [interquartile range (IQR) 18-26] and mean BP was 141/78 (SD 22/12) mmHg. Antihypertensive drugs were prescribed in 157 (87%). Participants were prescribed a median of 1 (IQR 1-2) antihypertensive medication. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers were the most frequently prescribed antihypertensives in 63% of participants. Target BP was achieved in 58% (95% confidence interval 49%-64%). Increasing number of antihypertensives was not associated with lower systolic or diastolic BP, or with a higher proportion of patients attaining target BP. Participants had 214 falls, 3 had a fracture, 3 developed symptomatic heart failure, 4 had cerebrovascular events, and 8 died.
Conclusions/Implications:
In this population of people with mild dementia, participants were treated with standard antihypertensive medications in a similar proportion to the general population, with a similar proportion achieving target BP. The rate of adverse health events was higher than in randomized controlled trials of antihypertensives and raises reservations about the assumptions underpinning antihypertensive treatment in people with dementia. These findings may help inform clinical decision making.
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