Sustained reduction of systolic blood pressure (SBP) to below 120 mmHg may modestly decrease dementia risk, with differing impacts across racial and ethnic groups, according to a recent study.
The Multi-Ethnic Study of Atherosclerosis cohort included 6,806 participants aged 44 to 84 years, with a follow-up period of 19 years. Researchers used the parametric g-formula to simulate interventions aimed at maintaining SBP below 120 mmHg and 140 mmHg, and evaluated their effects on dementia incidence.
Over the follow-up period, 587 new dementia cases were diagnosed. The cumulative incidence rates of dementia were 11.4% for White participants, 8.9% for Black participants, 8.3% for Latino participants, and 5% for Chinese-American participants. The overall risk ratio (RR) for maintaining SBP below 120mm Hg was 0.93; stratified RRs were 0.95 for White participants, 0.90 for Black participants, 0.90 for Latino participants, and 1.16 for Chinese-American participants. The effect was less pronounced for a maintenance SBP below 140 mmHg vs 120 mmHg.
Interventions had a greater effect on participants younger than 65 years at baseline, with an RR of 0.86 for those under 65 compared to 0.95 for those 65 and older. The strategies showed no significant effect for men but were more effective for women, who had RRs of 0.94 for maintaining SBP below 140 mmHg and 0.87 for maintaining SBP below 120 mmHg.
These findings, published in Alzheimer's & Dementia, suggest the need for tailored hypertension management strategies to address the varying dementia risks across racial and ethnic groups and emphasize the importance of addressing structural inequities contributing to higher hypertension prevalence among Black and Latino adults. The study also indicates the need for inclusive clinical research to understand the effects of health interventions on diverse populations.
Full disclosures are available in the published study.