Intervention Review

Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia

  1. Bernadette McGuinness1,*,
  2. Stephen Todd1,
  3. Peter Passmore1,
  4. Roger Bullock2

Editorial Group: Cochrane Dementia and Cognitive Improvement Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 25 NOV 2008

DOI: 10.1002/14651858.CD004034.pub3

How to Cite

McGuinness B, Todd S, Passmore P, Bullock R. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD004034. DOI: 10.1002/14651858.CD004034.pub3.

Author Information

  1. 1

    Queen's University Belfast, Department of Geriatric Medicine, Belfast, UK

  2. 2

    Kingshill Research Centre, Victoria Hospital, Swindon, UK

*Bernadette McGuinness, Department of Geriatric Medicine, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, UK.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 7 OCT 2009




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要


This is an update of a previous review (McGuinness 2006).

Hypertension and cognitive impairment are prevalent in older people. Hypertension is a direct risk factor for vascular dementia (VaD) and recent studies have suggested hypertension impacts upon prevalence of Alzheimer's disease (AD). Therefore does treatment of hypertension prevent cognitive decline?


To assess the effects of blood pressure lowering treatments for the prevention of dementia and cognitive decline in patients with hypertension but no history of cerebrovascular disease.

Search methods

The Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS as well as many trials databases and grey literature sources were searched on 13 February 2008 using the terms: hypertens$ OR anti-hypertens$.

Selection criteria

Randomized, double-blind, placebo controlled trials in which pharmacological or non-pharmacological interventions to lower blood pressure were given for at least six months.

Data collection and analysis

Two independent reviewers assessed trial quality and extracted data. The following outcomes were assessed: incidence of dementia, cognitive change from baseline, blood pressure level, incidence and severity of side effects and quality of life.

Main results

Four trials including 15,936 hypertensive subjects were identified. Average age was 75.4 years. Mean blood pressure at entry across the studies was 171/86 mmHg. The combined result of the four trials reporting incidence of dementia indicated no significant difference between treatment and placebo (236/7767 versus 259/7660, Odds Ratio (OR) = 0.89, 95% CI 0.74, 1.07) and there was considerable heterogeneity between the trials. The combined results from the three trials reporting change in Mini Mental State Examination (MMSE) did not indicate a benefit from treatment (Weighted Mean Difference (WMD) = 0.42, 95% CI 0.30, 0.53). Both systolic and diastolic blood pressure levels were reduced significantly in the three trials assessing this outcome (WMD = -10.22, 95% CI -10.78, -9.66 for systolic blood pressure, WMD = -4.28, 95% CI -4.58, -3.98 for diastolic blood pressure).
Three trials reported adverse effects requiring discontinuation of treatment and the combined results indicated no significant difference (OR = 1.01, 95% CI 0.92, 1.11). When analysed separately, however, more patients on placebo in Syst Eur 1997 were likely to discontinue treatment due to side effects; the converse was true in SHEP 1991. Quality of life data could not be analysed in the four studies.
Analysis of the included studies in this review was problematic as many of the control subjects received antihypertensive treatment because their blood pressures exceeded pre-set values. In most cases the study became a comparison between the study drug against a usual antihypertensive regimen.

Authors' conclusions

There is no convincing evidence from the trials identified that blood pressure lowering in late-life prevents the development of dementia or cognitive impairment in hypertensive patients with no apparent prior cerebrovascular disease. There were significant problems identified with analysing the data, however, due to the number of patients lost to follow-up and the number of placebo patients who received active treatment. This introduced bias. More robust results may be obtained by conducting a meta-analysis using individual patient data.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要

There is no convincing evidence from randomized controlled trials that blood pressure lowering in late life prevents the development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease.

Hypertension and cognitive impairment are prevalent in older people. We found four trials suitable for analysing the effectiveness of blood pressure lowering for preventing development of cognitive impairment and dementia. However, for several reasons, including the differing methodologies of the trials, the number of drop-outs from the trials, and active treatment of subjects in the control groups, we were unable to assess definitively the effectiveness of antihypertensive treatments for preventing cognitive impairment and dementia in people with no evidence of previous cerebrovascular disease.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要



本レビューは、先のレビュー(McGuinness 2006)の改訂版である。高齢者では高血圧や認知障害が一般的にみられる。高血圧は血管性認知症(VaD)の直接的な危険因子であり、最近の研究からアルツハイマー病(AD)の有病率に及ぼす高血圧の影響が示唆されている。それでは、高血圧治療は認知機能の低下を予防するか?




2008年2月13日に、検索語「hypertens$」または「anti-hypertens$」を用いて、Specialized Register of the Cochrane Dementia and Cognitive Improvement Group、コクラン・ライブラリ、MEDLINE、EMBASE、PsycINFO、CINAHL、LILACSならびに多数の試験データベースおよび灰色文献情報源を検索した。






高血圧の被検者15,936例を対象とした4件の試験を同定した。平均年齢は75.4歳であった。研究全体での登録時の平均血圧は171/86mmHgであった。認知症の罹患率を報告していた4件の研究のデータを統合した結果、治療群とプラセボ群との間で有意差は認められず(7,767例中236例に対して7,660例中259例、オッズ比(OR)=0.89、95%CI0.74~1.07)、試験の間でかなりの異質性があった。Mini Mental State Examination(MMSE)の変化を報告していた3件の試験のデータを統合した結果、治療による利益は認められなかった(重み付け平均差(WMD)=0.42、95%CI0.30~0.53)。収縮期血圧値および拡張期血圧値はともに、このアウトカムを評価していた3件の試験で有意に低下していた(収縮期血圧についてWMD=-10.22、95%CI-10.78~-9.66、拡張期血圧についてWMD=-4.28、95%CI -4.58~-3.98)。3件の試験は治療中止を必要とする有害作用を報告しており、統合した結果からはその有意差は認められなかった(OR=1.01、95%CI 0.92~1.11)。しかし、個別に解析したところ、SystEur 1997においてはプラセボ治療患者が副作用により治療を中止する傾向が高かった。SHEP 1991ではこの逆の結果になった。4件の研究でQOLデータは解析できなかった。コントロール群被検者の多くで事前に設定していた血圧の値を上回っていたため降圧治療を受けていたことからすると本レビューに含めた研究の解析は、問題があった。ほとんどの場合、研究は被験薬と通常の降圧薬レジメンとの比較となった。




監  訳: 大神 英一,2010.2.10

実施組織: 厚生労働省委託事業によりMindsが実施した。

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  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







在2008年2月13日利用「hypertens OR antihypertens」關鍵字針對Specialized Register of the Cochrane Dementia and Cognitive Improvement Group、Cochrane Library、MEDLINE、EMBASE、PsycINFO、CINAHL、LILACS等資料庫進行檢索,而其中也包括試許多驗資料庫和灰色文獻。






4個試驗包含15936位高血壓患者,受試者的平均年齡為75.4歲,在進入跨越試驗的平均血壓值為171/86毫米汞柱,4個試驗的合併結果顯示失智症的發生率在治療組和安慰劑組之間並沒有顯著差異(236/7767和259/7660,OR值為0.89,95%的信心區間介於0.74至1.07之間),在試驗之間存在有一定程度的異質性。3個試驗整合的結果顯示治療組在簡易智能狀態量表(MMSE)的變化上並沒有明顯助益(WMD值為.42,95%的信心區間介於0.30至0.53之間), 3個試驗檢測出的收縮壓和舒張壓有明顯的降低現象(對收縮壓來說,WMD值為 −10.22,95%的信心區間介於 −10.78至 −9.66之間,對舒張壓來說,WMD值為 −428,95%的信心區間介於 −4.58至3.98之間)。有3個試驗有提出出現需要停止治療的不良事件,且混合的結果顯示並沒有顯著差異(OR值為.01,95%的信心區間介於0.92至1.11之間),當個別進行分析的時候,Syst Eur 1997的試驗中,有較多安慰劑組的患者因為副作用而必須中斷治療,但是SHEO1991的試驗中卻出現相反的結果,在4個試驗中無法針對生活品質方面的數據進行分析。有許多對照組的受試者因為血壓超過預設值而接受抗高血壓藥物的治療,所以針對納入本研究的試驗進行分析有許多問題。在大多數的案例中,試驗會變成針對藥物和一般抗高血壓療程進行的比較。




此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


並沒有由隨機性對照試驗取得的證據可以說明在患有高血壓但是沒有心血管病史患者的晚年生活中降低血壓可以預防失智症或認知功能障礙的發生。 高血壓和認知功能障礙通常與老年人有關,我們發現4個針對降低血壓對於預防認知功能障礙和失智症進行分析的試驗,但是基於多項理由,包括各個試驗使用不同方法、由試驗中排除的受試者人數和對照組患者所接受的主動治療等,我們沒有辦法明確的評估使用抗高血壓藥物在治療患有高血壓但是沒有心血管病史患者中,對於預防失智症或認知功能障礙的功效。