Impact of Different Poststroke Antihypertensive Regimens on Cardiovascular Outcomes and Mortality in People with Dementia: Four Continents for Dementia (4C4D) Study

Friday, August 26, 2022

2:30 PM – 2:45 PM CEST

Location: C1M0

Publication Number: 53

Background: People with dementia have a higher incidence of poststroke disability and mortality than people without dementia. Hypertension is a major modifiable risk factor for recurrent stroke. Stroke guidelines do not make specific recommendations for combining different antihypertensives in people with dementia.

Objectives: Our objective was to investigate different poststroke dual antihypertensive regimens and cardiovascular outcomes and mortality in people with dementia in Australia, Hong Kong, United Kingdom (UK) and Unites States (US).

Methods: We conducted a cohort study of people aged >30 years discharged from hospital following ischaemic stroke using electronic medical records and linked health data from Australia, Hong Kong, UK and US using a distributed network approach. Medication categories included renin-angiotensin system inhibitor (RASI) and calcium channel blocker (CCB), RASI and beta-blocker, and RASI and thiazide diuretic (TZD). Outcomes included recurrent non-fatal or fatal ischemic stroke, major adverse cardiac event (MACE) and all-cause mortality. Results from country-specific, inverse probability of treatment weighted, Cox proportional hazards regression analyses were combined using meta-analyses stratified for people with and without dementia.

Results: The study comprised 28,062 people discharged on dual antihypertensive regimens, of whom 3502 had diagnosed dementia. Compared to RASI and CCB, RASI and beta-blocker did not impact all-cause mortality (hazard ratio [HR] 1.08; 95%CI 0.85-1.39), MACE (HR 1.34; 95%CI [0.97-1.85]) or recurrent stroke (HR 1.67; 95%CI 0.87-3.23) in people with dementia. RASI and TZD did not impact all-cause mortality (HR 1.43; 95%CI 0.80-2.58), MACE (HR 1.00; 95%CI 0.76-1.31) or recurrent stroke (HR 0.86; 95%CI 0.54-1.37) in dementia. A similar pattern of associations was observed for people without dementia.

Conclusions: Based on pooled estimates across four countries, different dual antihypertensive regimens are equally effective as one-another at preventing recurrent non-fatal or fatal ischemic stroke, MACE and all-cause mortality in people with and without dementia.

Presenting Author(s)

Jenni Ilomaki, PhD

Senior Lecturer
Monash University
Parkville, Victoria, Australia

Slides

Co-Author(s)

XQ

Xiwen Simon Qin

University of Hong Kong, Hong Kong
CC

Celine SL Chui

School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China, Hong Kong
GF

Gang Fang

Associate Professor
University of North Carolina at Chapel Hill, United States
WL

Wallis Lau

Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom, United Kingdom
SW

Stephen J Wood

Monash University
Parkville, Australia
SK

Stella Kim

Monash University, Australia
ML

Miriam TY Leung

Monash University, Australia
IA

Izabela Annis

Senior Analyst
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
TM

Tian Ma

University College London
London, United Kingdom
IW

Ian Wong

Professor
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China, Hong Kong
GL

Gary KK Lau

Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
JB

J. Simon Bell

Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia, Australia