title: The treatment of hypertension in people with dementia: a systematic review of observational studies.
abstract: BACKGROUND
  Hypertension is very common in older people and a number of trials of antihypertensives have demonstrated benefit from treatment in even the oldest old. However, people with dementia were significantly under-represented in these studies and as a population are more likely to be physically frail, to suffer orthostatic hypotension and to experience adverse effects from polypharmacy at a lower drug count. It may be that different thresholds for commencement and cessation of treatment should be considered and may already be used for this group. Against this background this review sets out to describe the prevalence of hypertension in people with dementia, its treatment, change in treatment over time and the achievement of blood pressure (BP) control.
  
  
  METHODS
  The PubMed, Cochrane, Embase and PsychINFO databases were searched for observational studies involving people with dementia and a diagnosis of hypertension. The search was limited to English language articles involving adults and humans published from 1990 onwards. Abstracts and titles were then reviewed with eligible articles read in full. Bibliographies were examined for further relevant studies. The final selection of studies was then analysed and appraised.
  
  
  RESULTS
  Thirteen articles were identified for analysis. The prevalence of hypertension in people with dementia was 45% (range 35%-84%). 73% of these were on at least one antihypertensive, with diuretics being the most common. The reported prevalence of hypertension in study populations remained unchanged over time. ACEi/ARBs and calcium channel blockers were prescribed more frequently in more recent studies whilst use of β-blockers and diuretics remained unchanged. Target blood pressure was achieved in 55% of those on treatment.
  
  
  CONCLUSIONS
  Hypertension is as common in people with dementia as in other populations and is as commonly treated with antihypertensive drugs. The findings presented here will support further work to establish the risk-benefit of antihypertensive treatment in patients with dementia and, if differing ratios are identified, to establish dementia-specific guidelines for management.
authors: Division of Rehabilitation and Ageing, School of Medicine, B99, B Floor, University of Nottingham, Nottingham NG7 2UH, UK. tomas.welsh@nottingham.ac.uk.
authors: Tomas J
authors: TJ
authors: Welsh
authors: John R
authors: JR
authors: Gladman
authors: Adam L
authors: AL
authors: Gordon
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D064887:Observational Studies as Topic / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents