• Tan Edwin C K ECK Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Aging Research Center, Cen, Chengxuan Qiu, Yajun Liang, Rui Wang, J Simon Bell, Johan Fastbom, Laura Fratiglioni, and Kristina Johnell.
• Center for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden. Electronic address: edwin.tan.@monash.edu.
• J Am Med Dir Assoc. 2018 Jul 1; 19 (7): 577-583.

ObjectiveTo investigate the association between antihypertensive medication regimen intensity and risk of incident dementia in an older population.DesignProspective, longitudinal cohort study.Participants/SettingA total of 1208 participants aged ≥78 years, free of dementia, and residing in central Stockholm at baseline (2001-2004).MeasurementsParticipants were examined at 3- and 6-year follow-up to detect incident dementia. Data were collected through face-to-face interviews, clinical examinations, and laboratory tests. Data on antihypertensive use were obtained by a physician through patient self-report, visual inspection, or medical records. Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-varying antihypertensive regimen intensity and incident dementia after adjusting for potential confounders.ResultsDuring the follow-up period, 125 participants were diagnosed with dementia. Participants who developed dementia were more likely to have vascular disease at baseline (66.4% vs 55.3%, P = .02). In fully adjusted analyses, the number of antihypertensive classes (HR 0.68, 95% CI 0.55-0.84) and total prescribed daily dose (HR 0.70, 95% CI 0.57-0.86) were significantly associated with reduced dementia risk. After considering all-cause mortality as a competing risk, the number (HR 0.75, 95% CI 0.62-0.91) and doses (HR 0.71, 95% CI 0.59-0.86) of antihypertensive classes, and the independent use of diuretics (HR 0.66, 95% CI 0.44-0.99), were significantly associated with lower dementia risk.ConclusionsGreater intensity of antihypertensive drug use among older people may be associated with reduced incidence of dementia.Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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