Risk of Incident Dementia in Drug-Untreated Arterial Hypertension: A Population-Based Study

Article type: Research Article

Authors: Bermejo-Pareja, Félix^{a; b} | Benito-León, Julián^{a; b; *} | Louis, Elan D.^{c; d; e; f} | Trincado, Rocío^{a; b} | Carro, Eva^g | Villarejo, Alberto^a | de la Cámara, Agustín Gómez^{h; i}

Affiliations: [a] Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain | [b] Centro de Investigaciín Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain | [c] The G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA | [d] Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA | [e] Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA | [f] Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA | [g] Neuroscience Laboratory, Research Center, University Hospital “12 de Octubre”, Madrid, Spain | [h] Clinical Epidemiology Unit, University Hospital “12 de Octubre”, Madrid, Spain | [i] Centro de Investigación Biomédica en Red sobre Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

Correspondence: [*] Correspondence to: Dr. Julián Benito-León, Avda. de la Constitución 73, portal 3, 7° Izquierda, E-28821 Coslada, Madrid, Spain. E-mail: jbenitol@meditex.es.

Abstract: Arterial hypertension in midlife may increase the risk of late-life dementia. Notably, there is conflicting data as to whether hypertension in the elderly (age 65 years and older) is a risk factor for dementia and Alzheimer's disease (AD). We determined whether drug-untreated hypertension was associated with a higher risk of incident dementia and AD. In a population-based study of older people in central Spain (NEDICES), non-demented participants were followed prospectively. Dementia at follow-up was diagnosed using DSM-IV criteria. Using Cox proportional hazards models, the risk of dementia was estimated in participants with drug-untreated hypertension and in participants with drug-treated hypertension versus controls. The 3,824 participants had a mean duration of follow-up of 3.2 years. Sixty-two (3.3%) of 1,870 participants without baseline hypertension developed incident dementia versus 78 (4.7%) of 1,657 with drug-treated, baseline hypertension and 19 (12.0%) with drug-untreated, baseline hypertension. In an unadjusted Cox model, risk of dementia was increased in participants with drug-untreated hypertension (relative risk [RR] = 1.93, 95% confidence interval [CI] = 1.15–3.23, p = 0.01) and in participants with drug-treated hypertension (RR = 1.43, 95% CI = 1.02–2.0, p = 0.035) versus participants without hypertension (reference group). In a fully adjusted Cox model, the risk of dementia remained increased in participants with drug-untreated hypertension (RR = 2.38, 95% CI = 1.32–4.29, p = 0.004). Results were similar for risk of AD. Our results suggest that drug-untreated hypertension may be an independent risk factor for dementia and AD in the elderly.

Keywords: Dementia, elderly, epidemiology, hypertension

DOI: 10.3233/JAD-2010-101110

Journal: Journal of Alzheimer's Disease, vol. 22, no. 3, pp. 949-958, 2010