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Cross-Sectional and Longitudinal Association Between Antihypertensive Medications and Cognitive Impairment in an Elderly Population

¹ Palmetto Health Richland Senior Primary Care Practice, Columbia, South Carolina.
² Division of Geriatrics, Department of Medicine, University of South Carolina, School of Medicine, Columbia.

Address correspondence to Ihab Hajjar, MD, MS, Clinical Assistant Professor of Internal Medicine, Division of Geriatrics, Department of Medicine, Palmetto Health Richland, University of South Carolina, School of Medicine. E-mail: ihab.hajjar{at}palmettohealth.org

Background. The effect of antihypertensive medications on cognitive function has not been well studied. The authors' objectives were to investigate the cross-sectional and longitudinal association between the use of antihypertensive medications and cognitive function and to compare different antihypertensive medication classes with regard to this association in an elderly population.

Methods. The medical records of a convenience sample of patients (n = 993 cross-sectional and 350 longitudinal; mean age, 76.8 ± 0.3 years; 74% women; 87% White) followed at a geriatric practice were reviewed. Data abstracted included demographics, medical history (Alzheimer's disease [AD] or vascular dementia [VaD]), use of antihypertensive medications, and results of cognitive assessments (the Mini-Mental Status Examination [MMSE] and the Clock Draw Test [CDT]).

Results. In the cross-sectional analysis, antihypertensive use was not associated with MMSE (p >.05), CDT (p >.05), or dementia diagnosis (odds ratio for AD, 0.8; 95% confidence interval [CI], 0.6 to 1.2; odds ratio for VaD, 1.6; 95% CI, 0.6 to 4.0). In the longitudinal analysis, antihypertensive use was associated with a lower rate of cognitive decline on the MMSE (–0.8 ± 2 points in users vs –5.8 ± 2.5 points in nonusers; p =.007) and on the CDT (–0.3 ± 0.8 points in users vs –2.2 ± 0.8 points in nonusers; p =.002), and with a lower risk for the development of cognitive impairment (odds ratio, 0.56; 95% CI, 0.38 to 0.83; p =.004). The trend was similar in patients with baseline AD (p =.02). Patients taking diuretics (p =.007), angiotensin-converting enzyme inhibitors (p =.016), and beta-blockers (p =.014) had a lower rate of cognitive decline, and patients taking angiotensin receptor blockers (p =.016) had improved cognitive scores.

Conclusions. Antihypertensive use, particularly diuretics, angiotensin-converting enzymes inhibitors, beta-blockers, and angiotensin receptor blockers, may be associated with a lower rate of cognitive decline in older adults, including those with AD. Until a randomized clinical trial confirms our results, findings of this observational study should be interpreted with caution.