Tomas J Welsh1, Adam L Gordon2, John R F Gladman3. 1. Research Institute for the Care of Older People (RICE), Bath, Somerset, United Kingdom; Royal United Hospital Bath NHS Foundation Trust, Bath, Somerset, United Kingdom; University of Bristol, Bristol, United Kingdom. Electronic address: tomas.welsh@nhs.net. 2. University of Nottingham, Nottingham, Nottingham, United Kingdom; University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, United Kingdom; Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, United Kingdom; NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, United Kingdom. 3. University of Nottingham, Nottingham, Nottingham, United Kingdom; Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, United Kingdom; NIHR Nottingham Biomedical Research Centre, Nottingham, Nottinghamshire, United Kingdom.
Abstract
OBJECTIVES: To describe the treatment of hypertension in people with dementia and collate evidence on adverse health events whilst on treatment. DESIGN: A multicenter prospective observational cohort study. SETTING AND PARTICIPANTS: People with documented diagnoses of hypertension and dementia were recruited through memory clinics and general practice from 8 sites in the United Kingdom. METHODS: The cohort was recruited between July 2013 and October 2014. Participants underwent face-to-face, standardized assessment of blood pressure (BP), activities of daily living, cognitive function, and medication use. Follow-up was by monthly telephone interview for 6 months to collate data on adverse health events. RESULTS: 181 participants were recruited and 177 followed up; 126 (70%) were female, mean age was 82 [standard deviation (SD) 6.3] years, median Mini-Mental State Examination score was 23 [interquartile range (IQR) 18-26] and mean BP was 141/78 (SD 22/12) mmHg. Antihypertensive drugs were prescribed in 157 (87%). Participants were prescribed a median of 1 (IQR 1-2) antihypertensive medication. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers were the most frequently prescribed antihypertensives in 63% of participants. Target BP was achieved in 58% (95% confidence interval 49%-64%). Increasing number of antihypertensives was not associated with lower systolic or diastolic BP, or with a higher proportion of patients attaining target BP. Participants had 214 falls, 3 had a fracture, 3 developed symptomatic heart failure, 4 had cerebrovascular events, and 8 died. CONCLUSIONS/IMPLICATIONS: In this population of people with mild dementia, participants were treated with standard antihypertensive medications in a similar proportion to the general population, with a similar proportion achieving target BP. The rate of adverse health events was higher than in randomized controlled trials of antihypertensives and raises reservations about the assumptions underpinning antihypertensive treatment in people with dementia. These findings may help inform clinical decision making.
OBJECTIVES: To describe the treatment of hypertension in people with dementia and collate evidence on adverse health events whilst on treatment. DESIGN: A multicenter prospective observational cohort study. SETTING AND PARTICIPANTS: People with documented diagnoses of hypertension and dementia were recruited through memory clinics and general practice from 8 sites in the United Kingdom. METHODS: The cohort was recruited between July 2013 and October 2014. Participants underwent face-to-face, standardized assessment of blood pressure (BP), activities of daily living, cognitive function, and medication use. Follow-up was by monthly telephone interview for 6 months to collate data on adverse health events. RESULTS: 181 participants were recruited and 177 followed up; 126 (70%) were female, mean age was 82 [standard deviation (SD) 6.3] years, median Mini-Mental State Examination score was 23 [interquartile range (IQR) 18-26] and mean BP was 141/78 (SD 22/12) mmHg. Antihypertensive drugs were prescribed in 157 (87%). Participants were prescribed a median of 1 (IQR 1-2) antihypertensive medication. Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers were the most frequently prescribed antihypertensives in 63% of participants. Target BP was achieved in 58% (95% confidence interval 49%-64%). Increasing number of antihypertensives was not associated with lower systolic or diastolic BP, or with a higher proportion of patients attaining target BP. Participants had 214 falls, 3 had a fracture, 3 developed symptomatic heart failure, 4 had cerebrovascular events, and 8 died. CONCLUSIONS/IMPLICATIONS: In this population of people with mild dementia, participants were treated with standard antihypertensive medications in a similar proportion to the general population, with a similar proportion achieving target BP. The rate of adverse health events was higher than in randomized controlled trials of antihypertensives and raises reservations about the assumptions underpinning antihypertensive treatment in people with dementia. These findings may help inform clinical decision making.