Effect of intensive blood pressure reduction for the prevention of cognitive decline and dementia: A systematic review and meta‐analysis
Bibliographic record
Abstract
Abstract Background High blood pressure is a treatable, high risk factor for both cerebrovascular disease and cognitive impairment. Antihypertensive treatment can be viewed therefore as a potential approach to reduce dementia risk. We aimed to examine the effectiveness and safety of intensive, as opposed to standard, blood pressure reduction in adults with hypertension for the primary or secondary prevention of cognitive decline and dementia. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials reporting on intensive versus guideline blood pressure targets and cognitive outcomes by searching MEDLINE (Ovid), Embase (Embase.com), CENTRAL, Web of Science, CINAHL, PsycINFO (Ovid), ICTRP and ClinicalTrials.gov databases up to October 27, 2020. Titles and abstracts screening, full‐texts review, data extraction, and risk of bias assessment were performed in duplicates. Conflicts were resolved by an independent reviewer. Our primary outcome was cognitive decline from baseline. Secondary outcomes included incidence of dementia, mild cognitive impairment, cerebrovascular events, serious adverse events, and mortality. Results We identified five trials (17,396 participants), reported in fourteen publications meeting our inclusion criteria among 7,755 screened citations. The mean follow‐up duration was 3.3 years (range 2.0 to 4.7 years). Intensive blood pressure reduction was not associated with a significant change in global cognitive performance at follow‐up (SMD 0.01, 95% CI ‐0.04 to 0.06), incidence of dementia (RR 1.09, 95% CI 0.32 to 3.67) or incidence of mild cognitive impairment (RR 0.91, 95% CI 0.73 to 1.14) when compared to standard treatment. However, we found a significant reduction of cerebrovascular events in the intensive treatment arm (RR 0.79, 95% CI 0.67‐0.93), with no increased risk of serious adverse events (RR 1.13, 95% CI 0.91‐1.40) or mortality (RR 0.93, 95% CI 0.75‐1.15). Conclusions We found insufficient evidence to justify more intensive blood pressure reduction for the prevention of cognitive decline and dementia in adults with hypertension. Prospective, randomized trials with longer follow‐ups may be necessary to highlight such potential benefits.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.034 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.021 | 0.033 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".