Hypertension in people with dementia – what should we do?

Tomas Welsh is a Clinical Lecturer in the Medicine of Older People at the University of Nottingham, England. (First blogged on the BGS blog)

Antihypertensive therapy is effective even in the oldest old. However, the large trials of antihypertensive medications, even in older people, frequently excluded people with dementia. This causes difficulties in applying these findings to many of our typical patient group.

People with dementia are more likely to be physically frail, are at higher risk of adverse events due to polypharmacy and are more likely to experience orthostatic hypotension than their cognitively intact peers.  There is reason to suspect, therefore, that the risk-benefit ratio of treating hypertension may be different in this group and many clinicians intuitively feel this to be the case.  

We are currently embarking on a programme of research with the intention of helping to clarify this uncertainty and to provide some guidance on the optimal treatment of hypertension in this cohort. The initial step in this project sets out to describe how hypertension is currently treated in people with dementia, whether doctors follow generic guidelines or whether they attenuate their practice in light of the above considerations. To achieve this aim we have devised an observational study to describe current practice, and a literature review to examine relevant existent data.  The first output of the project – a literature review concerning management of hypertension in care homes – can be found here.