New horizons: the management of hypertension in people with dementia.
The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful. Robust evidence is scant, trials of antihypertensive medications have generally excluded those with dementia. Observational data show changes in risk association over the life course, with high BP being a risk factor for cognitive decline in mid-life, while low BP is predictive in later life. It is therefore possible that excessive BP lowering in older people with dementia might harm cognition. From the existing literature, there is no direct evidence of benefit or harm from treating hypertension in people with dementia. So what practical steps can the clinician take? Assess capacity, establish patient preferences when making treatment decisions, use ambulatory monitoring to thoroughly assess BP, individualise and consider deprescribing where side effects (e.g. hypotension) outweigh the benefits. Future research might include pragmatic randomised trials of targeted deprescribing, which include patient-centred outcome measures to help support decision-making and studies to address mechanistic uncertainties.
The Alzheimer Scotland Dementia Research Centre, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.
Jennifer Kirsty
JK
Harrison
Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.
Veronika
V
Van Der Wardt
Department of Health Sciences, University of Leicester, Leicester, UK.
Simon Paul
SP
Conroy
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
David J
DJ
Stott
Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.
Tom
T
Dening
University of Nottingham - Division of Medical Sciences and Graduate Entry Medicine, Nottingham, UK.
Adam Lee
AL
Gordon
Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.
Pip
P
Logan
Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.
Tomas James
TJ
Welsh
Division of Primary Care, University of Nottingham, Nottingham, UK.
Jaspal
J
Taggar
Nottingham University Hospitals NHS Trust, Nottingham, UK.
Rowan
R
Harwood
Division of Rehabilitation & Ageing, University of Nottingham, Nottingham, UK.
John R F
JR
Gladman
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents
decision-making; dementia; deprescribing; hypertension; individualise; older people