Hypertension and dementia: exploring the evidence

Jenni Harrison is a Clinical Research Fellow at The University of Edinburgh. Her previous role was as an Academic Clinical Fellow in Geriatric Medicine in Leicester. She was part of the Hypertension in Dementia (HIND) Research Group at the Universities of Nottingham and Leicester. The group recently produced a New Horizons article on the management of hypertension in people with dementia. She tweets @JenniKHarrison.

deerIn the face of uncertainty around the optimal management of hypertension in people with dementia we sought to review and summarise the available evidence. After first considering the rationale for the treatment of hypertension and possible reasons why the approach could be different for those with dementia, we structured our review around three key questions:

(1) Do people with dementia experience greater adverse effects from antihypertensive medications?

(2) Is cognitive function protected or worsened by controlling blood pressure?

(3) Are there subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful? Continue reading

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 medicineHIND

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.   Continue reading