title: Antihypertensive medication use and risk of cognitive impairment: the Honolulu-Asia Aging Study.
abstract: OBJECTIVE
  To determine the associations between classes of antihypertensive medication use and the risk of cognitive impairment among elderly hypertensive men.
  
  
  METHODS
  The Honolulu-Asia Aging Study is a prospective, community-based cohort study of Japanese American men conducted in Honolulu, Hawaii. We examined 2,197 participants (mean age 77 years at cohort entry, 1991-1993, followed through September 2010) with hypertension and without dementia or cognitive impairment at baseline, who provided information on medication use. Cognitive function was assessed at 7 standardized examinations using the Cognitive Abilities Screening Instrument (CASI). Cognitive impairment was defined as a CASI score <74.
  
  
  RESULTS
  A total of 854 men developed cognitive impairment (median follow-up, 5.8 years). β-Blocker use as the sole antihypertensive drug at baseline was consistently associated with a lower risk of cognitive impairment (incidence rate ratio [IRR] 0.69; 95% confidence interval [CI] 0.50-0.94), as compared with men not taking any antihypertensive medications, adjusting for multiple potential confounders. The use of diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or vasodilators alone was not significantly associated with cognitive impairment. Results were similar excluding those with cardiovascular disease or <1 year of follow-up, and additionally adjusting for pulse pressure, heart rate, baseline and midlife systolic blood pressure, and midlife antihypertensive treatment (IRR 0.65; 95% CI 0.45-0.94). The association between β-blocker use and cognitive impairment was stronger among men with diabetes, men aged >75 years, and those with pulse pressure ≥70 mm Hg.
  
  
  CONCLUSIONS
  β-blocker use is associated with a lower risk of developing cognitive impairment in elderly Japanese American men.
authors.affiliation: VA Pacific Islands Health Care System, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA. rebecca.gelber@va.gov
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Gelber
authors.forename: G Webster
authors.initials: GW
authors.lastname: Ross
authors.forename: Helen
authors.initials: H
authors.lastname: Petrovitch
authors.forename: Kamal H
authors.initials: KH
authors.lastname: Masaki
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.forename: Lon R
authors.initials: LR
authors.lastname: White
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000187:drug effects / Q000208:ethnology* / Q000523:psychology; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001208:Asia / Q000208:ethnology; D001213:Asian / Q000208:ethnology*; D003072:Cognition Disorders / Q000208:ethnology* / Q000517:prevention & control / Q000523:psychology; D015331:Cohort Studies; D005500:Follow-Up Studies; D006254:Hawaii / Q000208:ethnology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology* / Q000523:psychology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents
references.citation: Neuropharmacology. 2013 Jan;64:137-44
references.pmid: 22824191
references.citation: Am J Geriatr Psychiatry. 2008 Nov;16(11):883-92
references.pmid: 18978249
references.citation: Neurology. 2000 Mar 28;54(6):1265-72
references.pmid: 10746596
references.citation: JAMA. 1995 Dec 20;274(23):1846-51
references.pmid: 7500533
references.citation: Arch Neurol. 2012 Dec;69(12):1632-8
references.pmid: 22964777
references.citation: Lancet. 1998 Oct 24;352(9137):1347-51
references.pmid: 9802273
references.citation: Lancet Neurol. 2008 Aug;7(8):683-9
references.pmid: 18614402
references.citation: Ann Intern Med. 2008 Mar 4;148(5):379-97
references.pmid: 18316756
references.citation: Arch Intern Med. 2012 Mar 12;172(5):442-4
references.pmid: 22412114
references.citation: J Gerontol A Biol Sci Med Sci. 2005 Jan;60(1):67-73
references.pmid: 15741285
references.citation: Curr Alzheimer Res. 2012 Jul;9(6):664-72
references.pmid: 22471866
references.citation: Stroke. 2006 Jan;37(1):33-7
references.pmid: 16339468
references.citation: J Alzheimers Dis. 2010;21(2):649-54
references.pmid: 20571219
references.citation: BMJ. 2010 Jan 12;340:b5465
references.pmid: 20068258
references.citation: J Lipid Res. 1990 Mar;31(3):545-8
references.pmid: 2341813
references.citation: Am J Ther. 2010 Jul-Aug;17(4):358-64
references.pmid: 20019592
references.citation: J Am Geriatr Soc. 2007 Aug;55(8):1161-7
references.pmid: 17661953
references.citation: Int Psychogeriatr. 1994 Spring;6(1):45-58; discussion 62
references.pmid: 8054493
references.citation: Hypertension. 2010 Jun;55(6):1352-9
references.pmid: 20404223
references.citation: J Gerontol A Biol Sci Med Sci. 2008 May;63(5):529-35
references.pmid: 18511759
references.citation: Am J Epidemiol. 1975 Dec;102(6):477-80
references.pmid: 1202949
references.citation: J Am Geriatr Soc. 2009 Nov;57(11):1975-81
references.pmid: 19793158
references.citation: Neurobiol Aging. 2000 Jan-Feb;21(1):49-55
references.pmid: 10794848
references.citation: Arch Neurol. 2006 May;63(5):686-92
references.pmid: 16533956
references.citation: Brain. 2011 Nov;134(Pt 11):3398-407
references.pmid: 22075523
references.citation: Neurobiol Aging. 2000 Jan-Feb;21(1):57-62
references.pmid: 10794849
references.citation: Int J Clin Pharmacol Ther. 2012 Mar;50(3):195-201
references.pmid: 22373832
references.citation: Circulation. 2011 Nov 22;124(21):2312-9
references.pmid: 22105196
references.citation: JAMA. 1996 Sep 25;276(12):955-60
references.pmid: 8805729
references.citation: Arch Neurol. 2010 Feb;67(2):187-92
references.pmid: 20142526
references.citation: Neurobiol Aging. 2011 Dec;32(12):2321.e1-12
references.pmid: 20579773
references.citation: Hypertension. 2012 Apr;59(4):780-6
references.pmid: 22392902