Deans' stroke musings: Dementia risk with antihypertensive use and blood pressure variability

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, July 15, 2016

Dementia risk with antihypertensive use and blood pressure variability

Ask your doctor what the hell this means for the blood pressure drugs you are taking. I don't understand.

Dementia risk with antihypertensive use and blood pressure variability

Phillip J. Tully, MPsych(Clin), PhD,
Jean-François Dartigues, MD, PhD,
Stephanie Debette, MD, PhD,
Catherine Helmer, PhD,
Sylvaine Artero, PhD and
Christophe Tzourio, MD, PhD

+Show Affiliations

Correspondence to Dr. Tzourio: christophe.tzourio@u-bordeaux.fr

Published online before print July 8, 2016, doi: http://dx.doi.org/10.1212/WNL.0000000000002946 Neurology 10.1212/WNL.0000000000002946

Abstract
Full Text (PDF)

Also available:
Data Supplement

Abstract

Objective: To determine the association between discrete antihypertensive drug classes and incident dementia controlling for blood pressure variability (BPV) in the preceding 4 years.

Methods: A total of 6,537 participants (mean age 79 years, 62% women) in a prospective population-based cohort were followed up for incident dementia. A 4-year time lag period was created to classify drug exposure and measure blood pressure. BPV (percent coefficient of variation [CV]) was regressed against 9 antihypertensive drug classes (BPV_reg). Cox regression models were employed to determine hazard ratios (HRs) for incident dementia thereafter according to drug class, adjusted for mean blood pressure, covariates, and BPV or BPV_reg.

Results: Over a median 8.4 years follow-up (interquartile range 6.7–9.0), lower dementia risk was associated with nondihydropyridine calcium channel blocker (HR 0.56; 95% confidence interval [CI] 0.31–1.00, p = 0.05) and loop diuretics (HR 0.45; 95% CI 0.22–0.93, p = 0.03) after adjusting for CV-BPV. Similar findings were obtained in analyses restricted to antihypertensive drug users for nondihydropyridine calcium channel blocker (HR 0.52; 95% CI 0.28–0.95, p = 0.03) and loop diuretics (HR 0.40; 95% CI 0.19–0.83, p = 0.01). All systolic BPV × antihypertensive drug interaction terms were not different from p < 0.05.

Conclusions: Nondihydropyridine calcium channel blocker and loop diuretics were associated with a reduced dementia risk independent of CV-BPV in the preceding 4 years. Systolic BPV was not the primary mechanism through which antihypertensive drug classes lower dementia risk.