AP-HP, Hôpital H. Mondor, A. Chenevier, Clinical Pharmacology.
J Hypertens. 2013 Jun;31(6):1073-82. doi: 10.1097/HJH.0b013e3283603f53.
Prevention of cognitive decline and dementia with blood pressure lowering treatments has shown inconsistent results. We compared the effects of different classes of antihypertensive drugs on the incidence of dementia, and on cognitive function.
We conducted a systematic review and included 19 randomized trials (18 515 individuals) and 11 studies (831 674 individuals) analysing the effects of antihypertensive treatment on cognition and on the incidence of dementia, respectively, in hypertensive patients without prior cerebrovascular disorders. Network meta-analysis was used for the comparison of antihypertensive classes.
Antihypertensive treatment, regardless of the drug class, had benefits on overall cognition [effect size 0.05, 95% confidence interval (CI) 0.02-0.07] and all cognitive functions except language. Antihypertensive treatment reduced the risk of all-cause dementia by 9%, with reference to the control group (hazard ratio 0.91, 95% CI 0.89-0.94), when randomized trials and observationnal studies were combined (n = 15). Result was not significant with randomized trials alone (n = 4). Angiotensin II receptor blockers (ARBs) had larger benefits than placebo on overall cognition (adjusted effect size 0.60 ± 0.18, P = 0.02). ARBs were more effective than β-blockers (0.67 ± 0.18, P = 0.01), diuretics (0.54 ± 0.19, P = 0.04) and angiotensin-converting enzyme inhibitors (0.47 ± 0.17, P = 0.04) in rank. The mean change in blood pressure did not differ significantly between the different antihypertensive drug classes.
Our results support the notion that antihypertensive treatment has beneficial effects on cognitive decline and prevention of dementia, and indicate that these effects may differ between drug classes with ARBs possibly being the most effective.
降低血压的治疗方法对预防认知能力下降和痴呆的效果并不一致。我们比较了不同类别的降压药物对痴呆发病率以及认知功能的影响。
我们进行了系统综述，纳入了 19 项随机试验（18515 人）和 11 项研究（831674 人），分别分析了降压治疗对高血压患者（无先前脑血管疾病）认知功能和痴呆发病率的影响。网络荟萃分析用于比较降压药物类别。
无论降压药物类别如何，降压治疗都有益于整体认知[效应量 0.05，95%置信区间（CI）0.02-0.07]和除语言外的所有认知功能。与对照组相比，降压治疗将所有原因导致的痴呆风险降低了 9%（危险比 0.91，95%CI 0.89-0.94），将随机试验和观察性研究结合起来（n=15）。单独进行随机试验时，结果不显著（n=4）。血管紧张素 II 受体阻滞剂（ARBs）在整体认知方面的获益大于安慰剂（调整后的效应量 0.60±0.18，P=0.02）。与β受体阻滞剂（0.67±0.18，P=0.01）、利尿剂（0.54±0.19，P=0.04）和血管紧张素转换酶抑制剂（0.47±0.17，P=0.04）相比，ARBs 的效果更优。不同降压药物类别之间的血压平均变化无显著差异。
我们的结果支持降压治疗对认知能力下降和预防痴呆有益的观点，并表明这些效果可能因药物类别而异，ARB 类药物可能最有效。
