Abstract
Purpose of reviewThere is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer’s disease; however, associations between antihypertensive medications (AHMs) and dementia risk are less consistent. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews are comprehensive. Our extensive review includes 15 observational and randomized controlled trials (RCTs) published over the last 5 years, assessing the relationship between AHM and cognitive impairment.Recent findingsAll classes of AHM showed similar result patterns in human studies with the majority of study results reporting point estimates below one and only a small number of studies (N = 15) reporting statistically significant results in favor of a specific class.SummaryOnly a small number of studies reported statistically significant results in favor of a specific class of AHM. Methodological limitations of the studies prevent definitive conclusions. Further work is now needed to evaluate the class of AHM and cognitive outcomes in future RCTs, with a particular focus on the drugs with the promising results in both animals and human observational studies.Electronic supplementary materialThe online version of this article (doi:10.1007/s11906-016-0674-1) contains supplementary material, which is available to authorized users.
Highlights
There is a long-established association between hypertension and increased risk of age-related cognitive decline and dementia [1], but the potential association between antihypertensive treatment and reduced risk of dementia has been harder to determine
The data were treated as a cohort for the purposes of the analysis since the clinical trial intervention had no impact on cognitive function [12]
For incident Alzheimer’s disease Diuretic users compared to other antihypertensive users and non-users HR 0.72 (0.56–0.93) Loop diuretic users compared to other antihypertensive users and non-users HR 0.98 (0.67–1.43) Thiazide diuretic users compared to other antihypertensive users and non-users HR
Summary
There is a long-established association between hypertension and increased risk of age-related cognitive decline and dementia [1], but the potential association between antihypertensive treatment and reduced risk of dementia has been harder to determine. The majority of observational studies, clinical trials, and systematic reviews in this area suggest that antihypertensive treatment may be associated with a decreased risk of cognitive decline and incident dementia. The results of individual studies vary widely; for example, one study showed a 50 % reduction in incident dementia, while another demonstrated no association between incident dementia and any type of antihypertensive use [2,3,4,5]. Fournier et al reported that calcium channel blocker (CCB) and angiotensin receptor blockers (ARBs) were the most promising
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