Published Online
on April 6, 2006

A more recent version of this article appeared on May 1, 2006

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Submitted on January 19, 2006
Accepted on February 10, 2006

Reducing the Risk of Dementia. Efficacy of Long-Term Treatment of Hypertension

Rita Peila PhD^*; Lon R. White MD, MPH; Kamal Masaki MD; Helen Petrovitch MD; and Lenore J. Launer PhD

From the Laboratory of Epidemiology (R.P., L.J.L.), Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD; the Pacific Health Research Institute (R.P., L.W., K.M., H.P.), Honolulu, Hawai; and the Department of Geriatric Medicine (L.W., K.M., H.P.), John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawai.

^* To whom correspondence should be addressed. E-mail: peilar{at}mail.nih.gov.

Background and Purpose--The efficacy of treating older persons for hypertension remains controversial. Although clinical trials suggest no short-term harm, or some benefits, there are little data on the effect on cognitive function of long-term antihypertensive treatment. We evaluated the risk of dementia and cognitive decline associated with duration of antihypertensive treatment.

Methods--Data are from the Honolulu Asia Aging Study on Japanese American men followed since 1965. The subjects included in this analysis were hypertensive from midlife and dementia-free in 1991 (mean age 76.7 years). In 1991, 1994 and 1997, global cognitive function was assessed with the Cognitive Abilities Screening Instrument (CASI) and dementia by a standardized examination using international criteria. The sample was grouped by treatment duration (never-treated hypertensives (NTH), <5 years, 5 to 12 years, >12 years). Normotensive subjects up to 1991 were included in the analysis as a control group.

Results--For each additional year of treatment there was a reduction in the risk of incident dementia (hazard ratio [HR]=0.94, 95% CI, 0.89 to 0.99). The risk for dementia in subjects with >12 years of treatment was lower compared to NTH (HR for dementia=0.40; 95% CI, 0.22 to 0.75 and for Alzheimer disease HR=0.35; 95% CI, 0.16 to 0.78) and was similar to the normotensives. Nondemented subjects with 5 to 12 years of treatment had lower yearly CASI decline compared to NTH.

Conclusions--Results suggest that in hypertensive men, the duration of the antihypertensive treatment is associated with a reduced risk for dementia and cognitive decline.

Key words: dementia • hypertension • treatment

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