title: Antihypertensive treatment and risk of dementia: a retrospective database study.
abstract: OBJECTIVE
  Vascular risk factors play an important role in the pathogenesis of vascular dementia, as well as in Alzheimer disease. The effect of antihypertensive medication on risk of dementia is unclear. The aim was to investigate the association between antihypertensive prescriptions and incident dementia, using a primary care database.
  
  
  METHODS
  The analysis was based on 575 general and internal practices in Germany (10/2003 - 09/2008) (Disease analyzer database). Antihypertensive medication (ATC codes) during 3 years before newly diagnosed dementia (ICD codes or specific medication) in 1,297 patients was compared to 1,297 controls without dementia after matching for age (mean age: 80.6 ± 8.6 y), sex (females: 62%) and date of diagnosis. Conditional logistic regression was used to calculate crude and adjusted odds ratios (95% confidence intervals).
  
  
  RESULTS
  Betablocker prescriptions (≥ 1 per year over 3 y) showed a significant inverse association with newly diagnosed dementia (Odds ratio, OR: 0.79 95% CI 0.61 - 0.99) after adjusting for demographic covariates, health care use, and cardiovascular and neurological comorbidity. In the fully adjusted model, ACE inhibitors also tended to be inversely associated with incident dementia, but failed statistical significance (OR 0.84 95% CI 0.65 - 1.08). Calcium channel blockers were positively related to cognitive impairment only in the crude analysis. The other drug groups were not significantly related to dementia (diuretics OR: 0.89; 0.67 - 1.19; angiotensin- 1-inhibitors OR: 1.04; 0.66 - 1.64).
  
  
  CONCLUSIONS
  This practice-based case-control study indicated a possible protective effect of some antihypertensive agents (betablockers, ACE-inhibitors) on the development of dementia. Randomized controlled trials are required to confirm this finding.
authors.affiliation: Department of General Practice, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Wagner
authors.forename: Andrea
authors.initials: A
authors.lastname: Icks
authors.forename: Heinz-Harald
authors.initials: HH
authors.lastname: Abholz
authors.forename: Detlef
authors.initials: D
authors.lastname: Schröder-Bernhardi
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016022:Case-Control Studies; D016208:Databases, Factual; D003704:Dementia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D018696:Neuroprotective Agents / Q000494:pharmacology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D018696:Neuroprotective Agents