000127833 001__ 127833
000127833 005__ 20241125101200.0
000127833 0247_ $$2doi$$a10.1001/jamanetworkopen.2023.33353
000127833 0248_ $$2sideral$$a134926
000127833 037__ $$aART-2023-134926
000127833 041__ $$aeng
000127833 100__ $$aLennon, Matthew J.
000127833 245__ $$aUse of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life
000127833 260__ $$c2023
000127833 5060_ $$aAccess copy available to the general public$$fUnrestricted
000127833 5203_ $$aImportanceThe utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested.ObjectivesTo assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group.Data Source and Study SelectionLongitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece).Data Extraction and SynthesisParticipants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines.Main Outcomes and MeasuresThe key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group.ResultsThe analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P = .001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P = .02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P = .07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses.Conclusions and RelevanceThis individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.
000127833 536__ $$9info:eu-repo/grantAgreement/ES/DGA/B15-17R$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/G03-128$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/01-0255$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/03-0815$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/06-0617$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/94-1562$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/97-1321E$$9info:eu-repo/grantAgreement/ES/ISCIII/FIS/98-0103$$9info:eu-repo/grantAgreement/ES/ISCIII-MINECO/PI16-00896$$9info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/12-02254$$9info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/19-01874
000127833 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000127833 590__ $$a10.5$$b2023
000127833 592__ $$a3.478$$b2023
000127833 591__ $$aMEDICINE, GENERAL & INTERNAL$$b12 / 329 = 0.036$$c2023$$dQ1$$eT1
000127833 593__ $$aMedicine (miscellaneous)$$c2023$$dQ1
000127833 594__ $$a16.0$$b2023
000127833 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000127833 700__ $$aLam, Ben Chun Pan
000127833 700__ $$aLipnicki, Darren M.
000127833 700__ $$aCrawford, John D.
000127833 700__ $$aPeters, Ruth
000127833 700__ $$aSchutte, Aletta E.
000127833 700__ $$aBrodaty, Henry
000127833 700__ $$aThalamuthu, Anbupalam
000127833 700__ $$aRydberg-Sterner, Therese
000127833 700__ $$aNajar, Jenna
000127833 700__ $$aSkoog, Ingmar
000127833 700__ $$aRiedel-Heller, Steffi G.
000127833 700__ $$aRöhr, Susanne
000127833 700__ $$aPabst, Alexander
000127833 700__ $$0(orcid)0000-0003-3025-8048$$aLobo, Antonio$$uUniversidad de Zaragoza
000127833 700__ $$0(orcid)0000-0003-2284-7862$$aDe-la-Cámara, Concepción$$uUniversidad de Zaragoza
000127833 700__ $$0(orcid)0000-0002-1252-2397$$aLobo, Elena$$uUniversidad de Zaragoza
000127833 700__ $$aBello, Toyin
000127833 700__ $$aGureje, Oye
000127833 700__ $$aOjagbemi, Akin
000127833 700__ $$aLipton, Richard B.
000127833 700__ $$aKatz, Mindy J.
000127833 700__ $$aDerby, Carol A.
000127833 700__ $$aKim, Ki Woong
000127833 700__ $$aHan, Ji Won
000127833 700__ $$aOh, Dae Jong
000127833 700__ $$aRolandi, Elena
000127833 700__ $$aDavin, Annalisa
000127833 700__ $$aRossi, Michele
000127833 700__ $$aScarmeas, Nikolaos
000127833 700__ $$aYannakoulia, Mary
000127833 700__ $$aDardiotis, Themis
000127833 700__ $$aHendrie, Hugh C.
000127833 700__ $$aGao, Sujuan
000127833 700__ $$aCarrière, Isabelle
000127833 700__ $$aRitchie, Karen
000127833 700__ $$aAnstey, Kaarin J.
000127833 700__ $$aCherbuin, Nicolas
000127833 700__ $$aXiao, Shifu
000127833 700__ $$aYue, Ling
000127833 700__ $$aLi, Wei
000127833 700__ $$aGuerchet, Maëlenn M.
000127833 700__ $$aPreux, Pierre-Marie
000127833 700__ $$aAboyans, Victor
000127833 700__ $$aHaan, Mary N.
000127833 700__ $$aAiello, Allison E.
000127833 700__ $$aNg, Tze Pin
000127833 700__ $$aNyunt, Ma Shwe Zin
000127833 700__ $$aGao, Qi
000127833 700__ $$aScazufca, Marcia
000127833 700__ $$aSachdev, Perminder S. S.
000127833 7102_ $$11003$$2027$$aUniversidad de Zaragoza$$bDpto. Anatom.Histolog.Humanas$$cArea Anatom.Embriol.Humana
000127833 7102_ $$11007$$2745$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Psiquiatría
000127833 7102_ $$11011$$2615$$aUniversidad de Zaragoza$$bDpto. Microb.Ped.Radio.Sal.Pú.$$cÁrea Medic.Prevent.Salud Públ.
000127833 773__ $$g6, 9 (2023), e2333353 [18 pp.]$$pJAMA netw. open$$tJAMA network open$$x2574-3805
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000127833 951__ $$a2024-11-22-12:11:15
000127833 980__ $$aARTICLE