Key result
Incident dementia linked to an immediate increase in antihypertensive prescribing before a three-year decline.
Why the study?
Hypertension is common in dementia and blood pressure-lowering drug treatment may vary widely, prompting an evaluation of prescribing trends before and after incident dementia diagnosis across multiple countries.
Does incident dementia diagnosis change the prescribing trends of blood pressure-lowering drugs in patients with hypertension?
Observational (n=108,822)
Yes
Does incident dementia diagnosis change the prescribing trends of blood pressure-lowering drugs in patients with hypertension?
Effect estimate: Estimate*100: 4.66 (Hong Kong level change) (95% CI 3.79-5.53)
p-value: p=<0.001
Incident dementia diagnosis is associated with an immediate, transient increase in blood pressure-lowering drug prescribing in most regions, followed by a long-term decline, suggesting a temporary period of heightened vigilance for blood pressure control.
May reflect short-term vigilance in BP control after dementia diagnosis; leaves open effects on outcomes in this observational cohort.
Background: Hypertension is common among people living with dementia and blood pressure-lowering drug (BPLD) treatment in dementia patients may vary widely between individuals and countries/regions. This study aimed to describe and evaluate how prescribing trends of BPLD change before and after incident dementia diagnosis using electronic health record databases across four countries/regions. Methods: Electronic health records were collected from Hong Kong, United Kingdom, Sweden, and Australia for this study. Study dates were based on data availability from each database and ranged from January 1st, 2000 to December 31st, 2020. The target population were people diagnosed with dementia, with a prior diagnosis of hypertension and prescription of BPLD. Time series analysis, similar to interrupted time series, was conducted to evaluate the prescribing trends of BPLD three years before and after dementia diagnosis. The primary outcome of interest was the monthly proportion of patients prescribed with a BPLD. Findings: 31,873 patients from Hong Kong, 59,108 from the UK, 5034 from Sweden and 12,807 from Australia were included in this study. The mean age ranged from 78.3 years in Australia to 81.1 years in Hong Kong at time series entry. BPLD prescribing decreased in the three years before dementia diagnosis (negative pre-dementia slope) across all four databases. A significant immediate increase in antihypertensive prescribing was observed immediately after incident dementia diagnosis in Hong Kong (Estimate∗100: 4.66, 95% CI: 3.79-5.53), Sweden (Estimate∗100: 2.24, 95% CI: 1.60-2.88), and Australia (Estimate∗100: 1.58, 95% CI: 1.07-2.09), while there was no significant level change in the UK. BPLD prescribing declined in the three years after diagnosis for all databases. Interpretation: This is the largest multinational population-based study to date investigating prescribing trends of BPLD before and after dementia diagnosis. The time series analysis results suggested that there was increased vigilance of blood pressure control shortly after dementia diagnosis. Funding: This study was supported by the Hong Kong Research Grants Council General Research Fund, No. 17113720.
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Cheung et al. (2025) conducted an observational in Dementia with a prior diagnosis of hypertension (n=108,822). Incident dementia diagnosis vs. Pre-dementia diagnosis period was evaluated on Monthly proportion of patients prescribed with a blood pressure-lowering drug (Estimate*100: 4.66 (Hong Kong level change), 95% CI 3.79-5.53, p=<0.001). Incident dementia diagnosis was associated with a significant immediate increase in antihypertensive prescribing in Hong Kong, Sweden, and Australia, followed by a declining trend over the subsequent three years.
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