Treating high blood pressure with medicines to prevent futur | Figure 1

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Treating high blood pressure with medicines to prevent future dementia or memory/thinking problems

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Observational studies following participants over many years have suggested that high blood pressure is associated with subsequent dementia or new problems with memory and thinking (cognitive impairment). It is important to establish if treating high blood pressure can reduce the risk of dementia and problems with memory and thinking. There is already clear evidence to support the treatment of high blood pressure after stroke. The evidence for treating high blood pressure in the absence of stroke was not as well established when this review protocol was written.

Key findings

We included 12 trials (30,412 participants) in this review. Treating high blood pressure with medicines may reduce the risk of dementia and problems with memory and thinking, but we were unable to confirm this using the data we have available. This may be due to shortcomings in the evidence available.

Some participants had side effects from medications, such as falls, that led to them stopping the medications. This is also an important consideration.

Limitations of the review

We were unable to find evidence to confirm that treating high blood pressure with medicines will prevent future dementia or problems with memory and thinking. Based on the evidence available, all we can say is that the methods used in the studies we looked at were not sufficient to answer our study question. In practice, we want to know if treating high blood pressure in mid‐life reduces dementia and problems with memory and thinking in later life. These studies were too short in duration to answer this question. They tended to be designed to investigate heart attack and stroke as outcome measures, with memory and thinking tests added on, which means they were less likely to include the numbers of people with problems with memory and thinking necessary to reliably answer the question. In the studies comparing active medicines and placebo (inactive medicine), many people in the placebo groups ultimately did receive active medicine which further complicated the results.

Antihypertensive treatment may prevent new problems with memory and thinking, or dementia, or both, despite the findings of this review. To be more confident in our conclusions, we would need studies that have more distinct treatment and placebo groups, and that treat participants starting at a younger age and with a longer follow‐up.

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