Renin‐Angiotensin System Inhibitor Use and Mortality in Older Hypertensive Patients With and Without Dementia: A Nationwide Registry‐Based Cohort Study

Figures

• 

  FIGURE 1. Patient selection flowchart. Patients with dementia were identified through SveDem (clinically confirmed dementia), through diagnoses or as a cause of death, and through electronic health records on prescriptions, diagnoses and causes of death (group of suspected dementia cases). This group was matched to up to four controls. Patients without hypertension were removed. Lastly, prevalent users of renin‐angotensin system inhibitors (RASI) and those whose dementia diagnosis was on or after the date of death were excluded. Prevalent users were defined as those who had a prescription earlier than one year before inclusion date. ACEIs, angiotensin converting enzyme inhibitors; ARBs, angiotensin II receptor blockers; ATC, anatomical therapeutic chemical code; ICD: International Classification of Diseases; NPR, National Patient Register; PDR, Prescribed Drug Register; SveDem, Swedish registry for cognitive disorders and dementia.

• 

  FIGURE 2. Propensity score matching exposed and unexposed cohorts. The total 158 176 patients who met the inclusion criteria (hypertension diagnosis, non‐prevalent‐RASI users), were divided into RASI and non‐RASI users. This whole cohort was matched 1:1 using propensity score with no replacement, leaving 20985 non‐RASI users who were compared to 20985 RASI users. In a separate step, ARB users were matched with ACEI users, leaving 4980 patients in each group. ACEIs, angiotensin converting enzyme; RASI, renin angiotensin system inhibitors.

• 

  FIGURE 3. RASI use and all‐cause mortality. Hazard ratios (HR) and 95% confidence intervals (95% CIs) are presented. The propensity score was calculated using the following variables: age, sex, dementia category (none, SveDem, electronic health records diagnosis), diagnosis year, income, education, marital status, region of birth, Charlson Comorbidity Index, high blood pressure with target organ damage, diabetes, heart failure, acute kidney injury, myocardial infarction, stroke, atrial fibrillation, alcohol‐related conditions, cancer, liver disease, and medications. ACEI, angiotensin converting enzyme inhibitors; ARB, angiotensin receptor blockers; EHR dementia, Dementia from electronic health records: patients identified through prescriptions, in‐hospital or specialist diagnoses and causes of death; RASI, renin‐angiotensin system inhibitors. SveDem, patients registered in the Swedish Registry for Cognitive/Dementia Disorders.