title: Dementia risk with antihypertensive use and blood pressure variability: A cohort study.
abstract: OBJECTIVE
  To determine the association between discrete antihypertensive drug classes and incident dementia controlling for blood pressure variability (BPV) in the preceding 4 years.
  
  
  METHODS
  A total of 6,537 participants (mean age 79 years, 62% women) in a prospective population-based cohort were followed up for incident dementia. A 4-year time lag period was created to classify drug exposure and measure blood pressure. BPV (percent coefficient of variation [CV]) was regressed against 9 antihypertensive drug classes (BPVreg). Cox regression models were employed to determine hazard ratios (HRs) for incident dementia thereafter according to drug class, adjusted for mean blood pressure, covariates, and BPV or BPVreg.
  
  
  RESULTS
  Over a median 8.4 years follow-up (interquartile range 6.7-9.0), lower dementia risk was associated with nondihydropyridine calcium channel blocker (HR 0.56; 95% confidence interval [CI] 0.31-1.00, p = 0.05) and loop diuretics (HR 0.45; 95% CI 0.22-0.93, p = 0.03) after adjusting for CV-BPV. Similar findings were obtained in analyses restricted to antihypertensive drug users for nondihydropyridine calcium channel blocker (HR 0.52; 95% CI 0.28-0.95, p = 0.03) and loop diuretics (HR 0.40; 95% CI 0.19-0.83, p = 0.01). All systolic BPV × antihypertensive drug interaction terms were not different from p < 0.05.
  
  
  CONCLUSIONS
  Nondihydropyridine calcium channel blocker and loop diuretics were associated with a reduced dementia risk independent of CV-BPV in the preceding 4 years. Systolic BPV was not the primary mechanism through which antihypertensive drug classes lower dementia risk.
authors.affiliation: From Neuroepidemiology, UMR897 (P.J.T., S.D., C.T.), and Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897 (J.-F.D., C.H.), University of Bordeaux, France; Freemasons Foundation Centre for Men's Health (P.J.T.), Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Neurology (S.D.), Bordeaux University Hospital, France; Department of Neurology (S.D.), Framingham Heart Study, Boston University School of Medicine, MA; INSERM U1061 (S.A.), La Colombière Hospital, University of Montpellier UM1; and INSERM (P.J.T., C.T.), Neuroepidemiology, UMR897, Bordeaux, France.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: From Neuroepidemiology, UMR897 (P.J.T., S.D., C.T.), and Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897 (J.-F.D., C.H.), University of Bordeaux, France; Freemasons Foundation Centre for Men's Health (P.J.T.), Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Neurology (S.D.), Bordeaux University Hospital, France; Department of Neurology (S.D.), Framingham Heart Study, Boston University School of Medicine, MA; INSERM U1061 (S.A.), La Colombière Hospital, University of Montpellier UM1; and INSERM (P.J.T., C.T.), Neuroepidemiology, UMR897, Bordeaux, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
authors.affiliation: From Neuroepidemiology, UMR897 (P.J.T., S.D., C.T.), and Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897 (J.-F.D., C.H.), University of Bordeaux, France; Freemasons Foundation Centre for Men's Health (P.J.T.), Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Neurology (S.D.), Bordeaux University Hospital, France; Department of Neurology (S.D.), Framingham Heart Study, Boston University School of Medicine, MA; INSERM U1061 (S.A.), La Colombière Hospital, University of Montpellier UM1; and INSERM (P.J.T., C.T.), Neuroepidemiology, UMR897, Bordeaux, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Debette
authors.affiliation: From Neuroepidemiology, UMR897 (P.J.T., S.D., C.T.), and Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897 (J.-F.D., C.H.), University of Bordeaux, France; Freemasons Foundation Centre for Men's Health (P.J.T.), Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Neurology (S.D.), Bordeaux University Hospital, France; Department of Neurology (S.D.), Framingham Heart Study, Boston University School of Medicine, MA; INSERM U1061 (S.A.), La Colombière Hospital, University of Montpellier UM1; and INSERM (P.J.T., C.T.), Neuroepidemiology, UMR897, Bordeaux, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Helmer
authors.affiliation: From Neuroepidemiology, UMR897 (P.J.T., S.D., C.T.), and Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897 (J.-F.D., C.H.), University of Bordeaux, France; Freemasons Foundation Centre for Men's Health (P.J.T.), Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Neurology (S.D.), Bordeaux University Hospital, France; Department of Neurology (S.D.), Framingham Heart Study, Boston University School of Medicine, MA; INSERM U1061 (S.A.), La Colombière Hospital, University of Montpellier UM1; and INSERM (P.J.T., C.T.), Neuroepidemiology, UMR897, Bordeaux, France.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Artero
authors.affiliation: From Neuroepidemiology, UMR897 (P.J.T., S.D., C.T.), and Epidemiology and Biostatistics, Institut National de la Santé et de la Recherche Médicale U897 (J.-F.D., C.H.), University of Bordeaux, France; Freemasons Foundation Centre for Men's Health (P.J.T.), Discipline of Medicine, School of Medicine, The University of Adelaide, Australia; Department of Neurology (S.D.), Bordeaux University Hospital, France; Department of Neurology (S.D.), Framingham Heart Study, Boston University School of Medicine, MA; INSERM U1061 (S.A.), La Colombière Hospital, University of Montpellier UM1; and INSERM (P.J.T., C.T.), Neuroepidemiology, UMR897, Bordeaux, France. christophe.tzourio@u-bordeaux.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tzourio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003704:Dementia / Q000453:epidemiology* / Q000503:physiopathology; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics