What are the benefits and harms of withdrawing antihypertensive treatment to prevent cognitive decline?

A. CIAPPONI

Cochrane Clinical Answers

CROSSREF

Año: 2018

2050-4217

For adults (mean age, 73 to 81 years) either hospitalized within 48 hours of a stroke with baseline systolic blood pressure (BP) of 140 to 220 mmHg, or with mild cognitive impairment (MCI) attending primary care with baseline systolic BP ≤ 160 mmHg, the impact of withdrawing or continuing antihypertensive treatment on cognitive function is uncertain; evidence is of low certainty, and benefit of withdrawal was seen only in end scores post stroke, not when baseline cognition was taken into account (change in score over time) in people with MCI. However, both systolic and diastolic BP were increased with antihypertensive withdrawal within seven days (on average, by 9.5 mmHg for systolic and by 5.1 mmHg for diastolic) and continued to be elevated at four months. These increases did not result in clear differences between groups in terms of mortality or cardiovascular events, but follow‐up lasted only three to four months, so the longer‐term impact remains unclear. No trial reported on the incidence of dementia or falls.