(38) The Association Between Antihypertensive Agents and Incident Alzheimer's Disease: A Systematic Review and Meta-Analysis of Observational Studies

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 712

Presenting Author(s)

Matthew Adesuyan, MPharm
– Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom., University College London, London, United Kingdom

Co-Author(s)

Ruth Brauer, PhD
– Lecturer in Pharmacoepidemiology, University College London (UCL), England, United Kingdom
Yogini Jani, PhD
– Honorary Associate Professor, University College London (UCL), England, United Kingdom

Background: Hypertension is a recognised risk factor for dementia. However, evidence for using antihypertensive agents to reduce the risk of Alzheimer’s disease (AD) in people with hypertension is inconclusive.

Objectives: To examine the association between antihypertensive agents and the incidence of Alzheimer’s disease in adults with hypertension and normal cognition.

Methods: A literature search of MEDLINE, EMBASE, PsycINFO, Web of Science and Scopus was conducted to identify observational studies published from inception to January 2022. Eligible studies were those that investigated the association between antihypertensive agents and incident AD in adults with hypertension and normal cognition. Studies with less than 12 months follow-up time were excluded. The comparison group was either non-antihypertensive users or alternative antihypertensive user. The risk of bias was assessed using The Risk of Bias in Non-randomised studies of Interventions (ROBINS-I) tool. Two separate meta-analyses were conducted, pooling the adjusted risk ratios (RR) of non-antihypertensive comparator (1) and antihypertensive comparator (2) study designs, with 95% confidence intervals and the use of a random effects model under the DerSimonian and Laird method. Subgroup and sensitivity analyses were performed and the level of heterogeneity of pooled estimates was assessed using Higgins I2 statistic.

Results: We included 9 studies, totalling 1,527,410 participants in this review. Meta-analysis of non-antihypertensive user comparator studies found that the use of antihypertensive agents is associated with a reduced risk of incident AD (RR= 0.93, 95 % CI 0.89-0.97; p= 0.002). Meta-analysis of antihypertensive comparator studies found evidence that angiotensin II receptor blocker (ARB) users are associated with a reduction in the risk of AD compared to other antihypertensive agents (RR= 0.78, 95 % CI 0.68-0.88; p< 0.001).

Conclusions: Our review provides evidence that the use of antihypertensive agents is associated with a lower incidence of AD. The use of ARBs may provide the most benefit among antihypertensive agents. Lowering raised blood pressure may not be the only mechanism for cognitive protection and further investigation of the role of angiotensin II on cognition is indicated.