Abstract
AbstractBackgroundHigh blood pressure is a treatable, high risk factor for both cerebrovascular disease and cognitive impairment. Antihypertensive treatment can be viewed therefore as a potential approach to reduce dementia risk. We aimed to examine the effectiveness and safety of intensive, as opposed to standard, blood pressure reduction in adults with hypertension for the primary or secondary prevention of cognitive decline and dementia.MethodsWe conducted a systematic review and meta‐analysis of randomized controlled trials reporting on intensive versus guideline blood pressure targets and cognitive outcomes by searching MEDLINE (Ovid), Embase (Embase.com), CENTRAL, Web of Science, CINAHL, PsycINFO (Ovid), ICTRP and ClinicalTrials.gov databases up to October 27, 2020. Titles and abstracts screening, full‐texts review, data extraction, and risk of bias assessment were performed in duplicates. Conflicts were resolved by an independent reviewer. Our primary outcome was cognitive decline from baseline. Secondary outcomes included incidence of dementia, mild cognitive impairment, cerebrovascular events, serious adverse events, and mortality.ResultsWe identified five trials (17,396 participants), reported in fourteen publications meeting our inclusion criteria among 7,755 screened citations. The mean follow‐up duration was 3.3 years (range 2.0 to 4.7 years). Intensive blood pressure reduction was not associated with a significant change in global cognitive performance at follow‐up (SMD 0.01, 95% CI ‐0.04 to 0.06), incidence of dementia (RR 1.09, 95% CI 0.32 to 3.67) or incidence of mild cognitive impairment (RR 0.91, 95% CI 0.73 to 1.14) when compared to standard treatment. However, we found a significant reduction of cerebrovascular events in the intensive treatment arm (RR 0.79, 95% CI 0.67‐0.93), with no increased risk of serious adverse events (RR 1.13, 95% CI 0.91‐1.40) or mortality (RR 0.93, 95% CI 0.75‐1.15).ConclusionsWe found insufficient evidence to justify more intensive blood pressure reduction for the prevention of cognitive decline and dementia in adults with hypertension. Prospective, randomized trials with longer follow‐ups may be necessary to highlight such potential benefits.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
