Relationship of antihypertensives with late-life cognitive decline and neuropathology.

Antihypertensives (AHTs) are commonly used to treat high blood pressure and other conditions, but their associations with cognitive decline and common age-related neuropathologies are not well understood. More than 3300 participants from three harmonized community-based cohorts without baseline dementia were evaluated annually for changes in cognition and > 1800 participants were analyzed for post mortem neuropathology. In a linear mixed effect model adjusted for age, sex, education, and race/ethnicity, AHT use was associated with higher baseline global cognition (p < 0.001) and slower decline (p = 0.002) in global cognition, episodic memory, and semantic memory (all p < 0.02) compared to non-use. In the autopsy group AHT use was associated with a lower tau tangle density (p = 0.004), but not with other neurodegenerative or cerebrovascular pathologies. These associations did not change after controlling for blood pressure or other comorbidities. AHT use is associated with slower cognitive decline and lower tau pathology in late life. In this prospective study of > 3200 older, community-dwelling, persons followed for a mean of 8.6 years, those who used antihypertensive (AHT) medications during the study had slower cognitive decline, especially in episodic memory and semantic memory, compared to non-users. Among the > 1800 deceased and autopsied persons, AHT medication use was associated with fewer paired helical filament-positive tau tangles (a marker of Alzheimer's disease) but not with other neurodegenerative or cerebrovascular pathologies, compared to non-users. Based on observational data from a large dataset, AHT use in older persons was related to slower cognitive decline and less Alzheimer's disease pathology.