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Effect of intensive blood pressure reduction for the prevention of cognitive decline and dementia: A systematic review and meta‐analysis
Author(s) -
DallaireThéroux Caroline,
QuesnelOlivo MarieHélène,
Brochu Karine,
Bergeron Frédéric,
Laforce Robert,
Verreault Steve,
Camden MarieChristine,
Duchesne Simon
Publication year - 2021
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.053024
Subject(s) - medicine , dementia , cognitive decline , blood pressure , meta analysis , adverse effect , randomized controlled trial , incidence (geometry) , guideline , cinahl , relative risk , medline , psycinfo , physical therapy , intensive care medicine , pediatrics , disease , psychiatry , confidence interval , psychological intervention , pathology , physics , political science , law , optics
Background High 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. Methods We 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. Results We 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). Conclusions We 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.