Ruth Peters1, Andrew Booth, Jean Peters. 1. aImperial Clinical Trials Unit (ICTU), Imperial College London, London bSchool of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Abstract
OBJECTIVE: Treating hypertension in those aged at least 80 years is now recommended; however, the best antihypertensive to choose remains unexplored. Calcium channel blocker (CCB) use has been associated with a decreased risk of incident dementia in a younger hypertensive group but with an increased risk of cognitive decline in the very elderly. Either result could have a large impact on a vulnerable population. The aim of this review was to assess the evidence relating CCB use to later cognitive decline or dementia in the very elderly. METHODS: A systematic review of the literature was carried out. The databases Medline, PubMed, Embase and Psychinfo were searched from 1980 to 22 August 2013. Abstracts were reviewed by two independent reviewers and papers meeting the inclusion criteria were extracted. RESULTS: One thousand, nine hundred and sixty-eight records were reviewed and 10 articles reporting on nine studies retained and extracted. Data were primarily from cohort studies. Only one reported a randomized controlled trial comparing CCBs with placebo. Populations, comparator groups, follow-up times, outcomes and exposure varied and overall results were mixed. It was not possible to combine all studies, but those reporting Alzheimer's disease outcomes were combined to produce an overall risk ratio of 0.79 (95% confidence interval 0.53-1.17). CONCLUSION: At present, there is no clear evidence to suggest that CCB use increases or decreases risk of cognitive decline or dementia in the very elderly. A robust clinical trial is now required to resolve this.
OBJECTIVE: Treating hypertension in those aged at least 80 years is now recommended; however, the best antihypertensive to choose remains unexplored. Calcium channel blocker (CCB) use has been associated with a decreased risk of incident dementia in a younger hypertensive group but with an increased risk of cognitive decline in the very elderly. Either result could have a large impact on a vulnerable population. The aim of this review was to assess the evidence relating CCB use to later cognitive decline or dementia in the very elderly. METHODS: A systematic review of the literature was carried out. The databases Medline, PubMed, Embase and Psychinfo were searched from 1980 to 22 August 2013. Abstracts were reviewed by two independent reviewers and papers meeting the inclusion criteria were extracted. RESULTS: One thousand, nine hundred and sixty-eight records were reviewed and 10 articles reporting on nine studies retained and extracted. Data were primarily from cohort studies. Only one reported a randomized controlled trial comparing CCBs with placebo. Populations, comparator groups, follow-up times, outcomes and exposure varied and overall results were mixed. It was not possible to combine all studies, but those reporting Alzheimer's disease outcomes were combined to produce an overall risk ratio of 0.79 (95% confidence interval 0.53-1.17). CONCLUSION: At present, there is no clear evidence to suggest that CCB use increases or decreases risk of cognitive decline or dementia in the very elderly. A robust clinical trial is now required to resolve this.
Authors: Ruth Peters; Sevil Yasar; Craig S Anderson; Shea Andrews; Riitta Antikainen; Hisatomi Arima; Nigel Beckett; Joanne C Beer; Anne Suzanne Bertens; Andrew Booth; Martin van Boxtel; Carol Brayne; Henry Brodaty; Michelle C Carlson; John Chalmers; Maria Corrada; Steven DeKosky; Carol Derby; Roger A Dixon; Françoise Forette; Mary Ganguli; Willem A van Gool; Antonio Guaita; Ann M Hever; David B Hogan; Carol Jagger; Mindy Katz; Claudia Kawas; Patrick G Kehoe; Sirkka Keinanen-Kiukaanniemi; Rose Ann Kenny; Sebastian Köhler; Setor K Kunutsor; Jari Laukkanen; Colleen Maxwell; G Peggy McFall; Tessa van Middelaar; Eric P Moll van Charante; Tze-Pin Ng; Jean Peters; Iris Rawtaer; Edo Richard; Kenneth Rockwood; Lina Rydén; Perminder S Sachdev; Ingmar Skoog; Johan Skoog; Jan A Staessen; Blossom C M Stephan; Sylvain Sebert; Lutgarde Thijs; Stella Trompet; Phillip J Tully; Christophe Tzourio; Roberta Vaccaro; Eeva Vaaramo; Erin Walsh; Jane Warwick; Kaarin J Anstey Journal: Neurology Date: 2019-12-11 Impact factor: 9.910
Authors: Mark A Lovell; Erin Abner; Richard Kryscio; Liou Xu; Shuling X Fister; Bert C Lynn Journal: Oxid Med Cell Longev Date: 2015-06-28 Impact factor: 6.543