What is the clinical evidence from this study?

Study design: RCT. Population: Hypertension. Intervention: Indapamide sustained release +/- perindopril vs. Placebo. Primary outcome: Incident dementia.

What question did this study set out to answer?

To investigate the association between blood pressure parameters, particularly pulse pressure and diastolic blood pressure, and incident dementia in individuals aged 80 years and older.

June 6, 2013Journal of Hypertension

Increased pulse pressure linked to dementia

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Key result

Wider achieved pulse pressure was associated with an increased risk of incident dementia in both placebo (P=0.032) and active antihypertensive treatment (P=0.0046) groups.

Why the study?

Does wider pulse pressure predict incident dementia in patients aged >=80 years with systolic hypertension?

Key Points

To investigate the association between blood pressure parameters, particularly pulse pressure and diastolic blood pressure, and incident dementia in individuals aged 80 years and older.
Conducted a secondary analysis of the HYVET double-blind, placebo-controlled trial in patients aged ≥80 years with untreated systolic blood pressure of 160–199 mmHg.
Randomized participants to active therapy (indapamide sustained release 1.5 mg ± perindopril 2–4 mg to target <150/80 mmHg) or placebo, following them for a mean of 2.2 years.
Evaluated associations between baseline and achieved blood pressures (mean from 9 months onward) and incident dementia using Cox proportional hazards regression.
Baseline diastolic blood pressure was inversely associated with incident dementia (P=0.0064) across 263 incident dementia cases diagnosed during follow-up.
Achieved diastolic blood pressure showed a U-shaped association with dementia in the active treatment group (P=0.0195) but not in the placebo group (P=0.43; between-group difference P=0.38).
Wider achieved pulse pressure significantly increased dementia risk in both the placebo group (P=0.032) and the active treatment group (P=0.0046), whereas systolic blood pressure showed no significant association.

Study Design

Type

RCT

Blinding

Double-blind

Structured PICO

Does wider pulse pressure predict incident dementia in patients aged >=80 years with systolic hypertension?

Population

Very elderly patients (aged ≥80 years) with untreated systolic blood pressure of 160-199 mmHg, followed for a mean of 2.2 years.

Intervention

Indapamide sustained release 1.5 mg +/- perindopril 2-4 mg to reach goal pressure of less than 150/80 mmHg

Comparator

Placebo

Outcome

Incident dementiahard clinical

In very elderly patients with hypertension, wider achieved pulse pressure is associated with an increased risk of incident dementia.

Discussion

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Implication

Wider achieved pulse pressure signals higher dementia risk in very elderly hypertensives regardless of treatment; leaves open whether pulse pressure reduction alters incidence.

Cite This Study

Peters et al. (2013) conducted an RCT in Hypertension. Indapamide sustained release +/- perindopril vs. Placebo was evaluated on Incident dementia. Wider achieved pulse pressure was associated with an increased risk of incident dementia in both placebo (P=0.032) and active antihypertensive treatment (P=0.0046) groups.

synapsesocial.com/papers/6a81905db7134f4e3dee1bf8 https://doi.org/10.1097/hjh.0b013e3283622cc6

Topics

Hypertension management

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Implication

Wider achieved pulse pressure signals higher dementia risk in very elderly hypertensives regardless of treatment; leaves open whether pulse pressure reduction alters incidence.

Increased pulse pressure linked to dementia

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Increased pulse pressure linked to dementia

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider