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This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 72, Number 20, May 19, 2009 Japanese Translation All Versions of this Article: 01.wnl.0000345062.86148.3fv1 72/20/1727    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Haag, M.D.M. Articles by Stricker, B. H.C. Search for Related Content PubMed PubMed Citation Articles by Haag, M.D.M. Articles by Stricker, B. H.C. Related Collections All Cognitive Disorders/Dementia Alzheimer's disease All epidemiology Cohort studies Related Articles

Duration of antihypertensive drug use and risk of dementia

A prospective cohort study

From the Departments of Epidemiology (M.D.M.H., A.H., M.M.B.B., B.H.C.S.), Neurology (P.J.K.), and Internal Medicine (B.H.C.S.), Erasmus Medical Center, Rotterdam; and Inspectorate for Health Care (B.H.C.S.), The Hague, The Netherlands.

Address correspondence and reprint requests to Dr. Bruno H.C. Stricker, Department of Epidemiology, Erasmus Medical Center, P.O Box 2040, 3000 CA Rotterdam, The Netherlands b.stricker{at}erasmusmc.nl

Background: The evidence from prospective observational research for a protective effect of antihypertensive drug use on the risk of dementia is far from uniform. Duration of follow-up was limited and relied mainly on baseline drug exposure data without information on duration of use. We investigated the association between the duration of antihypertensive use and risk of dementia.

Methods: We followed 6,249 participants (mean 68.4 years, 60% women) of a prospective, population-based cohort from baseline (1990–1993) until 2005 for incident dementia. Continuous data on filled prescriptions came from pharmacy records. Total cumulative duration of antihypertensive use was expressed in years. We subtracted a latent 4-year period before the date of dementia diagnosis in the quantification of exposure duration to avoid potential bias in antihypertensive prescription due to prodromal changes in blood pressure or cognition. With Cox regression models, we calculated crude and adjusted hazard ratios (HRs) of all dementia and Alzheimer disease (AD) with antihypertensive use vs never used.

Results: Compared to never used, antihypertensive use was associated with a reduced risk of all dementia (adjusted HR per year of use 0.95; 95% confidence interval [CI] 0.91–0.99). We observed an 8% (95% CI –15% to –1%) risk reduction per year of use for persons 75 years, whereas for persons >75 years this was 4% (95% CI –11% to 4%). Equivalent estimates were observed for AD. No apparent differences were observed among different types of antihypertensive drugs.

Conclusions: Antihypertensive drug use was associated with 8% risk reduction of dementia per year of use for persons 75 years.

Abbreviations: ACE = angiotensin-converting enzyme; AD = Alzheimer disease; AT2 = angiotensin-2; ATC = Anatomic Therapeutic Chemical; BMI = body mass index; BP = blood pressure; CCB = calcium channel blocker; CHD = coronary heart disease; CI = confidence interval; DBP = diastolic blood pressure; DHP = dihydropyridine; DM = diabetes mellitus; DSM = Diagnostic and Statistical Manual of Mental Disorders; GMS = Geriatric Mental State schedule; HR = hazard ratio; MI = myocardial infarction; MMSE = Mini-Mental State Examination; NINCDS-ADRDA = National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association; NINDS-AIREN = National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche en l'Enseignement en Neurosciences; OR = odds ratio; RR = relative risk; SBP = systolic blood pressure.

Editorial, page 1716

See also page 1720

e-Pub ahead of print on February 18, 2009, at www.neurology.org.

The Rotterdam Study is supported by the Erasmus Medical Center and Erasmus University Rotterdam, the Netherlands Organization for Scientific Research, the Netherlands Organization for Health Research and Development, the Research Institute for Diseases in the Elderly, the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission, and the Municipality of Rotterdam.

Disclosure: The authors report no disclosures.

Received October 10, 2008. Accepted in final form January 9, 2009.

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