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Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis
Peters R, Xu Y, Fitzgerald O, Aung HL, Beckett N, Bulpitt C, et al.. European Heart Journal, 2022-12-21
Topic: Risk, prevention and care in population studies
Aims Observational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients. A pooled individual participant data analysis of five seminal randomized double-blind placebo-controlled trials was undertaken to better define the effects of BP-lowering treatment for the prevention of dementia. Methods and results Multilevel logistic regression was used to evaluate the treatment effect on incident dementia. Effect modification was assessed for key population characteristics including age, baseline systolic BP, sex, and presence of prior stroke. Mediation analysis was used to quantify the contribution of trial medication and changes in systolic and diastolic BP on risk of dementia. The total sample included 28 008 individuals recruited from 20 countries. After a median follow-up of 4.3 years, there were 861 cases of incident dementia. Multilevel logistic regression reported an adjusted odds ratio 0.87 (95% confidence interval: 0.75, 0.99) in favour of antihypertensive treatment reducing risk of incident dementia with a mean BP lowering of 10/4 mmHg. Further multinomial regression taking account of death as a competing risk found similar results. There was no effect modification by age or sex. Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk. Conclusion The first single-stage individual patient data meta-analysis from randomized double-blind placebo-controlled clinical trials provides evidence to support benefits of antihypertensive treatment in late-mid and later life to lower the risk of dementia. Questions remain as to the potential for additional BP lowering in those with already well-controlled hypertension and of antihypertensive treatment commenced earlier in the life-course to reduce the long-term risk of dementia. Classification of evidence Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo.
Key findings
- Aims Observational studies indicate U-shaped associations of blood pressure (BP) and incident dementia in older age, but randomized controlled trials of BP-lowering treatment show mixed results on this outcome in hypertensive patients.
- Methods and results Multilevel logistic regression was used to evaluate the treatment effect on incident dementia.
- Further multinomial regression taking account of death as a competing risk found similar results.
- Mediation analysis confirmed the greater fall in BP in the actively treated group was associated with a greater reduction in dementia risk.
- Classification of evidence Class I evidence in favour of antihypertensive treatment reducing risk of incident dementia compared with placebo.
Why it matters
This pooled analysis of individual participant data from five randomized placebo-controlled trials, including 28,008 people, found that antihypertensive treatment reduced the risk of incident dementia with a mean blood pressure lowering of 10/4 mmHg. It supports blood pressure lowering as a way to reduce dementia risk in hypertensive patients, but it is about prevention rather than treating existing dementia.
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Study details
- Study designmeta-analysis
- Participants28,008
- Effect sizeAdjusted OR 0.87 (95% CI 0.75-0.99) for incident dementia
- Evidence strengthHigh
Limitations
Trials of older adults with established hypertension over about four years; cannot say whether treatment earlier in life or in well-controlled patients adds benefit; a 2026 erratum has been published.
How this study scored 80/100
Published in a peer-reviewed journal, and it is a meta-analysis pooling many studies. We have no data on senior author's track record and free to read, so those were left out: it earned 75 of the 94 points we could judge it on, which is 80 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (European Heart Journal) |
| Journal's citation record | 3 / 4 | European Heart Journal: journal h-index 456 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A meta-analysis pooling many studies |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 28,008 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 5 / 7 | Cited 144 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 24.0 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 3 / 6 | Cited 6.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 10 other studies in this library |
| Still being cited | 3 / 4 | Cited 114 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 2 / 3 | Inserm: institution h-index 1,988 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 13 institution(s) in 5 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 36282295) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 75 / 94 | Scored on 18 of 20 parts. We have no data for the rest, so they are left out: 75 of the 94 points we could judge it on is 80 out of 100. |
| Total | 80 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1093/eurheartj/ehac584
- PubMed: 36282295
- Original source →
- Free full text: academic.oup.com →
Full text: free to read — Unpaywall lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Peters, R., Xu, Y., Fitzgerald, O., Aung, H. L., Beckett, N., Bulpitt, C., et al. (2022). Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis. European Heart Journal. https://doi.org/10.1093/eurheartj/ehac584
Vancouver
Peters R, Xu Y, Fitzgerald O, Aung HL, Beckett N, Bulpitt C, et al. Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis. European Heart Journal. 2022. doi:10.1093/eurheartj/ehac584. PMID: 36282295.
BibTeX
@article{peters2022-36282295,
author = {Peters, R. and Xu, Y. and Fitzgerald, O. and Aung, H. L. and Beckett, N. and Bulpitt, C. and others},
title = {{Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis}},
journal = {European Heart Journal},
year = {2022},
doi = {10.1093/eurheartj/ehac584},
pmid = {36282295},
url = {https://doi.org/10.1093/eurheartj/ehac584}
}
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