抗高血压药物种类、痴呆与认知能力下降的关系：一项荟萃分析。
Investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis.
机构信息
From Neuroscience Research Australia (R.P., K.J.A.); University of New South Wales (R.P., C.A., H.B., J.C., P.S.S., K.J.A.), Sydney, Australia; Johns Hopkins University (S.Y., M.C.C.), Baltimore, MD; The George Institute for Global Health (C.A., J.C.), Sydney, Australia; The George Institute China at Peking University Health Sciences Center (C.A.), Beijing, China; Icahn School of Medicine at Mount Sinai (S.A.), New York, NY; Center for Life Course Health Research/Geriatrics (R.A., S.K.-K., S.S., E.V.), University of Oulu; Medical Research Center Oulu (R.A.), Oulu University Hospital; Oulu City Hospital (R.A.), Finland; Department of Preventive Medicine and Public Health (H.A.), Fukuoka University, Japan; Guys and St Thomas' NHS Foundation Trust (N.B.), London, UK; University of Pittsburgh (J.C.B., M.G.), PA; Leiden University Medical Centre (A.S.B., S.T.), the Netherlands; University of Sheffield (A.B., J.P.), UK; School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology (M.v.B., S.K.), Maastricht University, the Netherlands; University of Cambridge (C.B.), UK; University of California (M.C., C.K.), Irvine; University of Florida (S.D.), Gainesville; Albert Einstein College of Medicine (C.D., M.K.), New York, NY; University of Alberta (R.A.D., G.P.M.), Edmonton, Canada; International Longevity Centre (F.F.), Paris, France; University of Amsterdam (W.A.v.G., E.P.M.v.C.), the Netherlands; Golgi Cenci Foundation (A.G., R.V.), Milan, Italy; Trinity College Dublin (A.H., R.A.K.), Ireland; University of Calgary (D.B.H.), Canada; Newcastle University (C.J., B.C.M.S.), Newcastle upon Tyne; University of Bristol (P.G.K., S.K.K.), UK; University of Eastern Finland (J.L.), Kuopio; Faculty of Sport and Health Sciences, University of Jyväskylä (J.L.), Finland; School of Pharmacy, University of Waterloo (C.M.), Ontario, Canada; Academic Medical Center (T.v.M., E.R.), Amsterdam; Donders Institute for Brain, Cognition and Behaviour (T.v.M., E.R.), Radboud University Medical Center, Nijmegen, the Netherlands; National University of Singapore (T.-P.N.); Sengkang General Hospital (I.R.), Singhealth Duke-NUS Academic Medical Centre, Singapore; Dalhousie University (K.R.), Halifax, Canada; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy (L.R., I.S.), and Department of Psychology (J.S.), Centre for Ageing and Health (AgeCap) at the University of Gothenburg, Sweden; University of Leuven (J.A.S., L.T.), Belgium; Bordeaux Population Health Research Center (P.J.T., C.T.), UMR 1219, CHU Bordeaux, University of Bordeaux, Inserm, France; University of Adelaide (P.J.T.); Australian National University (E.W.), Canberra, Australia; and University of Warwick (J.W.), Coventry, UK.
出版信息
Neurology. 2020 Jan 21;94(3):e267-e281. doi: 10.1212/WNL.0000000000008732. Epub 2019 Dec 11.
OBJECTIVE
High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.
METHODS
To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.
RESULTS
Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.
CONCLUSION
Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.
CLINICAL TRIALS REGISTRATION
The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.
目的
高血压是痴呆的主要可调节风险因素之一。然而，关于优化认知功能的最佳降压药物类别存在相互矛盾的证据。我们的目的是通过包括重新分析原始参与者数据的综合荟萃分析，确定任何特定的降压药物类别是否与认知能力下降或痴呆的风险降低相关。
方法
为了确定合适的研究，从开始到 2017 年 12 月，我们搜索了 MEDLINE、Embase 和 PsycINFO 以及预先存在的研究联盟。我们联系了前瞻性纵向人类研究或降压药物试验的作者，以获取数据共享和合作。结局指标为新发痴呆或新发认知能力下降（使用可靠变化指数方法进行分类）。数据分为中晚年（>65 岁）和每一种降压药物类别，并与未治疗和其他降压药物治疗进行比较。使用荟萃分析来综合数据。
结果
来自 27 项研究的 50,000 多名参与者被纳入研究。在年龄>65 岁的人群中，除利尿剂外，我们没有发现按类别与新发认知能力下降或痴呆的关系。利尿剂的使用在某些分析中提示有益，但结果在随访时间、比较组和结局方面并不一致。数据有限，无法对年龄≤65 岁的人群进行有意义的分析。
结论
我们从当前的证据基础中得出的发现支持在选择降压方案以实现血压目标时的临床自由。
临床试验注册
该综述在国际前瞻性系统评价注册库（PROSPERO）进行了注册，注册号为 CRD42016045454。
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