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Association of Antihypertensives and Cognitive Impairment in Long-Term Care Residents

Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Certain classes of antihypertensive medication may have different associations with cognitive impairment. OBJECTIVE: To examine the association between prevalent use of antihypertensive medications that stimulate (thiazides, dihydropyridine calcium channel blockers, angiotensin type I receptor blockers) versus inhibit (angiotensin-converting enzyme inhibitors, beta-blockers, non-dihydropyridine calcium channel blockers) type 2 and 4 angiotensin II receptors on cognitive impairment among older adults residing in Veterans Affairs (VA) nursing homes for long-term care. METHODS: Retrospective cohort study. Long-term care residents aged 65 + years admitted to a VA nursing home from 2012 to 2019 using blood pressure medication and without cognitive impairment at admission. Main exposure was prevalent use of angiotensin II receptor type 2 and 4-'stimulating' (N = 589), 'inhibiting' (N = 3,219), or 'mixed' (N = 1,715) antihypertensive medication regimens at admission. Primary outcome was any cognitive impairment (Cognitive Function Scale). RESULTS: Over an average of 5.4 months of follow-up, prevalent use of regimens containing exclusively 'stimulating' antihypertensives was associated with a lower risk of any incident cognitive impairment as compared to prevalent use of regimens containing exclusively 'inhibiting' antihypertensives (HR 0.83, 95% CI 0.74-0.93). Results for the comparison between 'mixed' versus 'inhibiting' regimens were in the same direction but not statistically significant (HR 0.96, 95% CI 0.88-1.06). CONCLUSION: For residents without cognitive impairment at baseline, prevalent users of regimens containing exclusively antihypertensives that stimulate type 2 and 4 angiotensin II receptors had lower rates of cognitive impairment as compared to prevalent users of regimens containing exclusively antihypertensives that inhibit these receptors. Residual confounding cannot be ruled out.
DOI: 10.3233/jad-215393
Authors: Zachary A. Marcum, Yongmei Li, Sei J. Lee, Michael A. Steinman, Laura Graham, Bocheng Jing, Kathy Fung, Carmen A. Peralta, Michelle C. Odden
Institutions: University of Washington, Stanford Medicine, Stanford University, San Francisco VA Medical Center, University of California, San Francisco, VA Palo Alto Health Care System, Northern California Institute for Research and Education, University of California San Francisco Medical Center
Language: English
Field: Medicine
Open Access status: green
Awards: Deprescribing Cardiovascular Medications among Persons with and without Alzheimer's Disease and Related Dementias in Long-Term Care, U.S. Deprescribing Research Network, Antihypertensives and the Aging Brain, Management of Hypertension among Persons with and without Dementia in Long-Term Care, Improving Care for Nursing Home residents with Diabetes and Cognitive Impairment, G950821093
OpenAlex ID: W4211118910
FWCI: 0.815
Cites: 35
Cited by: 8
Related to: 10