Antihypertensive medication classes and the risk of dementia: A systematic review and network meta‐analysis

Abstract

AbstractBackgroundHypertension is an important risk factor for dementia. Specific antihypertensive medication (AHM) classes may lower dementia risk more effectively than others. We aim to systematically review and synthesize the evidence on differential associations between AHM classes and the risk of dementia, using network meta‐analysis.MethodEmbase, MEDLINE and the Cochrane library were searched from origin to December 2019. We included randomized controlled trials and prospective cohort studies, including non‐demented participants with ≥one year of follow‐up. Data were extracted following PRISMA guidelines. Data on individual AHM classes were pooled using random effects frequentist network meta‐analysis.ResultFifteen observational studies and seven RCTs were included. Dementia occurred in 19,600/649,790 (3.02%) individuals. In observational studies, treatment with calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) conveyed lower dementia risks than treatment with other antihypertensives: CCBs compared to ACE‐inhibitors (HR=0.84, 95%CI 0.74‐0.95), beta blockers (BB) (HR=0.83, 95%CI 0.73‐0.95) and diuretics (HR=0.89, 95%CI 0.78‐1.01); ARBs compared to ACE‐inhibitors (HR=0.88, 95%CI 0.81‐0.97), BB (HR=0.87, 95%CI 0.77‐0.99) and diuretics (HR=0.93, 95%CI 0.83‐1.05). There were too few RCTs to create a robust network based on randomized data but similar conclusions were suggested.ConclusionRecommending CCBs or ARBs as preferred first‐line antihypertensive treatment may significantly reduce the risk of dementia. If confirmed in randomized trials, these findings reflect a low‐cost and scalable opportunity to reduce dementia incidence world‐wide.