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Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study.

Antihypertensive Medication and Dementia Risk in Older Adult African Americans with Hypertension: A Prospective Cohort Study.
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Murray MD, Hendrie HC, Lane KA, Zheng M, Ambuehl R, Li S, Unverzagt FW, Callahan CM, Gao S,


Murray MD, Hendrie HC, Lane KA, Zheng M, Ambuehl R, Li S, Unverzagt FW, Callahan CM, Gao S, (click to view)

Murray MD, Hendrie HC, Lane KA, Zheng M, Ambuehl R, Li S, Unverzagt FW, Callahan CM, Gao S,

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Journal of general internal medicine 2018 01 12() doi 10.1007/s11606-017-4281-x
Abstract
BACKGROUND
African Americans are especially at risk of hypertension and dementia. Antihypertensive medications reduce the risk of cardiovascular events, but may also reduce the risk of dementia.

OBJECTIVE
To assess the longitudinal effects of antihypertensive medications and blood pressure on the onset of incident dementia in a cohort of African Americans.

DESIGN
Prospective cohort.

PARTICIPANTS
1236 community-dwelling patients from an inner-city public health care system, aged 65 years and older, with a history of hypertension but no history of dementia, and who had at least three primary care visits and a prescription filled for any medication.

MAIN MEASURES
Blood pressure was the average of three seated measurements. Dementia was diagnosed using a two-stage design, with a screening evaluation every 2 to 3 years followed by a comprehensive in-home clinical evaluation for those with a positive screen. Laboratory, inpatient and outpatient encounter data, coded diagnoses and procedures, and medication records were derived from a health information exchange.

KEY RESULTS
Of the 1236 hypertensive participants without dementia at baseline, 114 (9%) developed incident dementia during follow-up. Individuals prescribed any antihypertensive medication (n = 816) were found to have a significantly reduced risk of dementia (HR = 0.57, 95% CI 0.37-0.88, p = 0.0114) compared to untreated hypertensive participants (n = 420). When this analysis was repeated including a variable indicating suboptimally treated blood pressure (> 140 mmHg systolic or >90 mmHg diastolic), the effect of antihypertensive medication was no longer statistically significant (HR = 0.65, 95% CI 0.32-1.30, p = 0.2217).

CONCLUSIONS
Control of blood pressure in older adult African American patients with hypertension is a key intervention for preventing dementia, with similar benefits from most of the commonly available antihypertensive medications.

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