Initiation of Antihypertensive Medication from Midlife on Incident Dementia: The Health and Retirement Study.
J Alzheimers Dis
; 94(4): 1431-1441, 2023.
Article
em En
| MEDLINE
| ID: mdl-37424471
ABSTRACT
BACKGROUND:
Hypertension has been identified as a risk factor of dementia, but most randomized trials did not show efficacy in reducing the risk of dementia. Midlife hypertension may be a target for intervention, but it is infeasible to conduct a trial initiating antihypertensive medication from midlife till dementia occurs late life.OBJECTIVE:
We aimed to emulate a target trial to estimate the effectiveness of initiating antihypertensive medication from midlife on reducing incident dementia using observational data.METHODS:
The Health and Retirement Study from 1996 to 2018 was used to emulate a target trial among non-institutional dementia-free subjects aged 45 to 65 years. Dementia status was determined using algorithm based on cognitive tests. Individuals were assigned to initiating antihypertensive medication or not, based on the self-reported use of antihypertensive medication at baseline in 1996. Observational analog of intention-to-treat and per-protocol effects were conducted. Pooled logistic regression models with inverse-probability of treatment and censoring weighting using logistic regression models were applied, and risk ratios (RRs) were calculated, with 200 bootstrapping conducted for the 95% confidence intervals (CIs).RESULTS:
A total of 2,375 subjects were included in the analysis. After 22 years of follow-up, initiating antihypertensive medication reduced incident dementia by 22% (RRâ=â0.78, 95% CI 0.63, 0.99). No significant reduction of incident dementia was observed with sustained use of antihypertensive medication.CONCLUSION:
Initiating antihypertensive medication from midlife may be beneficial for reducing incident dementia in late life. Future studies are warranted to estimate the effectiveness using large samples with improved clinical measurements.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Hipertensão
/
Anti-Hipertensivos
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article