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- Peters, Ruth, et al.
(author)
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An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis.
- 2020
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In: Neurology. - 1526-632X. ; 94:3
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Journal article (peer-reviewed)abstract
- High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.
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| 2. |
- Laird, Eamon, et al.
(author)
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Orthostatic hypotension and novel blood pressure associated gene variants in older adults : data from the TILDA Study
- 2020
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In: Journals of Gerontology. Series A: Biological Sciences & Medical Sciences. - : Oxford University Press (OUP). - 1758-535X. ; 75:11, s. 2074-2080
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Journal article (peer-reviewed)abstract
- Orthostatic hypotension (OH) is associated with increased risk of trauma and cardiovascular events. Recent studies have identified new genetic variants that influence orthostatic blood pressure (BP). The aim of this study was to investigate the associations of candidate gene loci with orthostatic BP responses in older adults. A total of 3,430 participants aged ≥50 years from The Irish Longitudinal Study on Ageing (TILDA) with BP measures and genetic data from twelve single-nucleotide polymorphism (SNP) linked to BP responses were analysed. Orthostatic BP responses were recorded at each 10 second interval and were defined as OH (SBP drop ≥20mmHg or DBP drop ≥10mmHg) at the time-points 40, 90 and 110 seconds. We defined sustained OH (SOH) as a drop that exceeded consensus BP thresholds for OH at 40, 90 and 110 seconds after standing. Logistic regression analyses modelled associations between the candidate SNP alleles and OH. We report no significant associations between OH and measured SNPs after correction for multiple comparisons apart from the SNP rs5068 where proportions of the minor allele was significantly different between cases and controls for SOH 40 (p=0.002). After adjustment for covariates in a logistic regression, those with the minor G allele (compared to the A allele) had a decreased incidence rate ratio (IRR) for SOH 40 (IRR 0.45, p=0.001, 95% CI 0.29-0.72). Only one SNP linked with increased natriuretic peptide concentrations was associated with OH. These results suggest that genetic variants may have a weak impact on OH but needs verification in other population studies.
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| 3. |
- McHugh Power, Joanna E., et al.
(author)
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Comparisons of the discrepancy between loneliness and social isolation across Ireland and Sweden : findings from TILDA and SNAC-K
- 2019
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In: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 54:9, s. 1079-1088
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Journal article (peer-reviewed)abstract
- Purpose Loneliness may have different cultural meanings in different countries. This may manifest as differing levels of Social Asymmetry-the discrepancy between loneliness and social isolation. Since loneliness is thought to be low in Sweden relative to more southerly countries, we hypothesised that more number of individuals would also fall into the discordant robust category of Social Asymmetry, i.e. that more individuals in Sweden would have lower loneliness levels relative to social isolation than in Ireland. We also explored the clinical relevance of Social Asymmetry in both countries, by examining its association with cognitive functioning.Methods We derived Social Asymmetry metrics in two representative cohort studies: the Irish Longitudinal Study on Ageing (TILDA) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Data pertaining to a dementia-free sample of 4565 Irish participants and 3042 Swedish participants, all aged over 60 years, were analysed using a multilevel modelling approach, with country as a higher-order variable.Results Contrary to the expected, more individuals in Ireland were discordant robust than in Sweden. We also found evidence for superior performance in global cognitive functioning among those in the discordant robust category relative to those in the discordant susceptible (i.e. those with higher levels of loneliness than social isolation) category, beta = 0.61, p < .001, across both countries.Conclusions Irish older adults may be more robust to the impact of social isolation on loneliness than those in the Swedish cohort. Social Asymmetry was related to cognitive functioning in both countries, suggesting that Social Asymmetry is a clinically relevant construct.
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