| アブストラクト | BACKGROUND: Hypertension in midlife is associated with increased risk of Alzheimer disease and vascular dementia late in life. In addition, some antihypertensive drugs have been proposed to have cognitive benefits, independent of their effect on hypertension. Consequently, there is potential to repurpose antihypertensive drugs for the prevention of dementia. This study systematically compared seven antihypertensive drug classes for this purpose, using the Clinical Practice Research Datalink. METHODS: We assessed treatments for hypertension in an instrumental variable analysis to address potential confounding and reverse causation. We used physicians' prescribing preference as an ordinal instrument, defined by the physicians' last seven prescriptions. Participants considered were new antihypertensive users between 1996 and 2016, aged 40 and over. RESULTS: We analyzed 849,378 patients, with total follow up of 5,497,266 patient-years. We estimated that beta-adrenoceptor blockers and vasodilator antihypertensives conferred small protective effects-for example, beta-adrenoceptor blockers were associated with 13 (95% confidence interval = 6, 20) fewer cases of any dementia per 1000 treated compared with other antihypertensives. CONCLUSIONS: We estimated small differences in the effects of antihypertensive drug classes on dementia outcomes. We also show that the magnitude of the differences between drug classes is smaller than that previously reported. Future research should look to implement other causal analysis methods to address biases in conventional observational research, with the ultimate aim of triangulating the evidence concerning this hypothesis. |
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| ジャーナル名 | Epidemiology (Cambridge, Mass.) |
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| 投稿日 | 2020/8/26 |
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| 投稿者 | Walker, Venexia M; Davies, Neil M; Martin, Richard M; Kehoe, Patrick G |
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| 組織名 | From the MRC University of Bristol Integrative Epidemiology Unit, Bristol, United;Kingdom.;Bristol Medical School: Population Health Sciences, University of Bristol,;Bristol, United Kingdom.;Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.;K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and;Nursing, NTNU, Norwegian University of Science and Technology, Norway.;Dementia Research Group, Bristol Medical School, University of Bristol, Bristol,;United Kingdom.;Bristol Medical School: Translational Health Sciences, University of Bristol, |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32841987/ |
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