Abstract Details

Title Evaluation of Intensive Versus Standard Blood Pressure Reduction and Association with Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis

Topic Aging and Dementia

Presentation(s) S15 - Aging and Dementia 1 (4:42 PM-4:54 PM)

Poster/Presentation
Number 007

Background High blood pressure (BP) is a treatable risk factor for both cerebrovascular disease and cognitive impairment. Antihypertensive therapy can be viewed therefore as a potential approach to reduce dementia risk.

Objective To examine the association of intensive, as opposed to standard, BP reduction on the incidence of cognitive decline and dementia.

Design/Methods We conducted a systematic review and meta-analysis of randomized controlled trials reporting on intensive versus guideline BP targets and cognitive outcomes by searching MEDLINE, Embase, CENTRAL, Web of Science, CINAHL, PsycINFO, ICTRP and ClinicalTrials.gov databases up to October 27, 2020. Titles and abstracts screening, full-texts review, data extraction, and risk of bias assessment were performed independently by two reviewers. Conflicts were resolved by a third reviewer. Our primary outcome was cognitive decline. Secondary outcomes included incidence of dementia, mild cognitive impairment, cerebrovascular events, serious adverse events, and mortality.

Results We identified five trials (17,396 participants, mean age 65.7 years), reported in fourteen publications meeting our inclusion criteria among 7,755 screened citations. The mean follow-up duration was 3.3 years (range 2.0-4.7 years). Intensive BP reduction was not associated with a significant change in global cognition (SMD 0.01, 95% CI -0.04-0.06), incidence of dementia (RR 1.09, 95% CI 0.32-3.67) or incidence of mild cognitive impairment (RR 0.91, 95% CI 0.73-1.14) when compared to standard treatment. However, we found a significant reduction of cerebrovascular events in the intensive treatment arm (RR 0.79, 95% CI 0.67-0.93), with no increased risk of serious adverse events (RR 1.13, 95% CI 0.91-1.40) or mortality (RR 0.93, 95% CI 0.75-1.15).

Conclusions Current evidence does not justify the use of intensive BP reduction for the prevention of cognitive decline in adults with hypertension. However, a well-designed randomized trial looking at longer term follow-up may be necessary to evaluate optimally the effect of more intensive BP control on cognitive decline.

Authors/Disclosures
Caroline Dallaire-Théroux, MD, PhD PRESENTER	Dr. Dallaire-Théroux has received research support from Canadian Institutes of Health Research (CIHR).
Marie-Hélène Quesnel-Olivo, MD (Hôpital de l'Enfant-Jésus)	Dr. Quesnel-Olivo has nothing to disclose.
Karine Brochu, MD (Hôpital de l'Enfant-Jésus)	Dr. Brochu has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Robert Laforce, Jr., MD, PhD (CHU De Quebec)	Dr. Laforce has nothing to disclose.
Steve Verreault, MD (Hopital De L'Enfant-Jesus)	The institution of Dr. Verreault has received research support from BMS. The institution of Dr. Verreault has received research support from Portola. The institution of Dr. Verreault has received research support from Daichii Sankyo.
Marie-Christine Camden, MD (Hôpital De L'Enfant-Jésus)	Dr. Camden has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pfizer.
Simon Duchesne, PhD (CRULRG)	Dr. Duchesne has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Qynapse SAS. Dr. Duchesne has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Nature Group. Dr. Duchesne has received stock or an ownership interest from Qynapse SAS. Dr. Duchesne has received intellectual property interests from a discovery or technology relating to health care.