Hypertension in people with dementia – what should we do?

Tomas Welsh is a Clinical Lecturer in the Medicine of Older People at the University of Nottingham and a recent recipient of a BGS grant to support research in geriatric medicine. 

Antihypertensive therapy is effective even in the oldest old. However, the large trials of antihypertensive medications, even in older people, frequently excluded people with dementia. This causes difficulties in applying these findings to many of our typical patient group.

People with dementia are more likely to be physically frail, are at higher risk of adverse events due to polypharmacy and are more likely to experience orthostatic hypotension than their cognitively intact peers.  There is reason to suspect, therefore, that the risk-benefit ratio of treating hypertension may be different in this group and many clinicians intuitively feel this to be the case.