Occurrence and progression of dementia in a community population aged 75 years and older - Relationship of antihypertensive medication use

Objective: To examine whether antihypertensive medication use can affect th e occurrence and progression of dementia. Subjects and Methods: In a community cohort of 1810 persons aged 75 years a nd older, 225 prevalent cases of dementia were detected. Among the 1301 per sons without dementia, 224 incident cases of dementia were identified durin g an average period of 3 years. Among the 225 prevalent cases of dementia, 79 were suitable for the analysis of cognitive decline. Information on drug use was collected for the 2 weeks preceding the baseline interview. Results: Subjects taking antihypertensive medication (n = 651, 83.9% of who m took diuretics) had a lower prevalence of dementia than those not taking antihypertensive medication (P < .001). Subjects without dementia who were taking antihypertensive medication at baseline (n = 584) had a reduced inci dence of dementia (adjusted relative risk, 0.7; 95% confidence interval, 0. 6-1.0; P = .03). Furthermore, subjects taking diuretics (n = 484) had an ad justed relative risk of 0.7 (95% confidence interval, 0.5-1.0; P = .02) for all dementia, and subjects taking diuretic monotherapy (n = 345) had an ad justed relative risk of 0.6 (95% confidence interval, 0.4-0.9; P = .006). T he use of other antihypertensive medication (calcium antagonists or beta-bl ockers), however, was related to a reduced risk of Alzheimer disease (adjus ted relative risk, 0.6; 95% confidence interval, 0.3-1.2) only in the subpo pulation with a higher baseline blood pressure (n = 458). Patients with dem entia at baseline who were not taking diuretics had a 2-fold faster rate of decline in the score on the Mini-Mental State Examination than those takin g diuretics. Conclusion: The use of diuretics may protect against dementia in elderly pe rsons.