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Hypertension Global Newsletter #3 Hype
Hype
CLINICAL PEARLS FROM THE FACULTY
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WATCH
PROF. LAURENT DISCUSS HIS
THOUGHTS ON ASSESSING THE
SAFETY AND EFFICACY OF FOURTH-
LINE ANTIHYPERTENSIVE AGENTS
TO CLINICAL PRACTICE.

Blood pressure lowering and prevention of dementia: An individual patient data
meta-analysis.

Peters R, et al. Eur Heart J. 2022 Oct 25;ehac584.

Previous observational studies in hypertensive Odds ratio for dementia vs. placebo by subgroup and overall
patients indicated a U-shaped association of BP and
incident dementia in older age but RCT of BP-lowering * Analysis adjusted for age, sex, and prior stroke, except where these variables define the subgroup.
treatments showed mixed results on this same outcome.
The Dementia rIsk REduCTion (DIRECT) study is a
pooled, individual participant, data analysis of five key
randomized, double-blind, placebo-controlled trials to
better define the effects of BP-lowering treatment for
the prevention of dementia. Previous study level meta-
analyses of antihypertensive trials and dementia were at
risk of bias in their estimates, but this patient-level meta-
analysis overcomes this limitation.

The total sample included 28,008 individuals (mean
age 69.1, SD 9.3 years, 46.8% female, baseline BP
155.8/82.9 mm Hg) from 20 countries. Median of follow-
up was 4.3 years. The pooled analysis demonstrated
that there was a significant effect of treatment in
lowering the odds of dementia (adjusted OR: 0.87, 95%
CI: 0.75, 0.99) with a sustained reduction in BP (mean
difference, ~10/4 mm Hg) in an older population with
a history of hypertension. There was no evidence of a
U-shaped relation at any age, nor any increase in risk
of dementia with treatment in the oldest age group. The
results were consistent across analyses that accounted
for the competing risk of mortality, and there were no
interactions by age, baseline BP, or history of stroke.

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