Veronika van der Wardt1, Pip Logan2, Simon Conroy3, Rowan Harwood4, John Gladman2. 1. Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom. Electronic address: v.vanderwardt@nottingham.ac.uk. 2. Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom. 3. Geriatric Medicine, University Hospitals of Leicester, Leicester, United Kingdom. 4. University of Nottingham, Nottingham, United Kingdom.
Abstract
BACKGROUND: The range and magnitude of potential benefits and harms of antihypertensive treatment in people with dementia has not been previously established. METHODS: A scoping review to identify potential domains of benefits and harms of antihypertensive therapy in people with dementia was undertaken. Systematic reviews of these domains were undertaken to examine the magnitude of the benefits or harms. RESULTS: Potential outcome domains identified in the 155 papers in the scoping review were cardiovascular events, falls, fractures and syncope, depression, orthostatic hypotension, behavioral disturbances, polypharmacy risks, kidney problems, sleep problems, interactions with cholinesterase inhibitors, and pain. The systematic reviews across these domains identified relatively few studies done in people with dementia, and no convincing evidence of safety, benefit, or harm across any of them. DISCUSSION: Given the lack of firm evidence of benefits or harm from antihypertensive therapy in people with dementia and the weak evidence for benefits in people over 80 years of age, the current presumption that the favorable evidence drawn from the treatment of nondemented people should be extrapolated to those with dementia is contentious. There is sufficient evidence to warrant particular caution and further research into treatment in this group of patients.
BACKGROUND: The range and magnitude of potential benefits and harms of antihypertensive treatment in people with dementia has not been previously established. METHODS: A scoping review to identify potential domains of benefits and harms of antihypertensive therapy in people with dementia was undertaken. Systematic reviews of these domains were undertaken to examine the magnitude of the benefits or harms. RESULTS: Potential outcome domains identified in the 155 papers in the scoping review were cardiovascular events, falls, fractures and syncope, depression, orthostatic hypotension, behavioral disturbances, polypharmacy risks, kidney problems, sleep problems, interactions with cholinesterase inhibitors, and pain. The systematic reviews across these domains identified relatively few studies done in people with dementia, and no convincing evidence of safety, benefit, or harm across any of them. DISCUSSION: Given the lack of firm evidence of benefits or harm from antihypertensive therapy in people with dementia and the weak evidence for benefits in people over 80 years of age, the current presumption that the favorable evidence drawn from the treatment of nondemented people should be extrapolated to those with dementia is contentious. There is sufficient evidence to warrant particular caution and further research into treatment in this group of patients.
Authors: Rianne A A de Heus; Rogier Donders; Angelina M M Santoso; Marcel G M Olde Rikkert; Brian A Lawlor; Jurgen A H R Claassen Journal: J Am Heart Assoc Date: 2019-05-21 Impact factor: 5.501
Authors: Veronika van der Wardt; Jennifer K Burton; Simon Conroy; Tomas Welsh; Pip Logan; Jaspal Taggar; Lukasz Tanajewski; John Gladman Journal: Pilot Feasibility Stud Date: 2018-01-09
Authors: Masayo Koide; Osama F Harraz; Fabrice Dabertrand; Thomas A Longden; Hannah R Ferris; George C Wellman; David C Hill-Eubanks; Adam S Greenstein; Mark T Nelson Journal: J Clin Invest Date: 2021-09-15 Impact factor: 14.808