Going Off Blood Pressure Meds Linked to Better Cognition

By Huey Freeman

Taking older adults off their blood pressure medication was linked to slower cognitive decline, especially in those with dementia, a new study published in JAMA Internal Medicine found.

The research, involving more than 12,000 participants, challenges previous assumptions about hypertension treatment in older adults and raises questions about optimal medication management in long-term care settings.

“Our results … suggest caution regarding intensive BP [blood pressure] control in older adults living in nursing homes, particularly those with cognitive impairment.” the authors wrote.

The researchers linked hypertension drug prescription with the over-prescription problem in older adults. Around half of older adults are taking five or more medications, which can present various health risks. Antihypertensive drugs are a major driver of polypharmacy, with 70 percent of older adults prescribed hypertension drugs.

Measurable Progress With Fewer Meds 

Taking patients off their antihypertensive drugs was linked to a 16 percent reduction in their risk of cognitive decline.

Researchers, primarily affiliated with the University of California, San Francisco, Stanford University, and VA medical centers, conducted a study involving more than 12,000 nursing home residents to examine the relationship between blood pressure medication and cognitive decline. All participants had some level of cognitive dysfunction.

The study took place over a 13-year period at VA long-term facilities where participants stayed for 12 weeks or longer. The study was funded by a grant from the National Institute on Aging.

“Our study suggests that deprescribing antihypertensives may protect nursing home residents from future cognitive losses, especially for those living with dementia,” the authors wrote.

“While elevated blood pressure, BP, in midlife is a well-documented risk factor for cognitive decline, the optimal BP targets for older adults—especially those in nursing homes—remain unclear,” they wrote.

Previous clinical trials produced mixed results on the effects of blood pressure medication on reducing cognitive decline. The authors said that their study differed from others by focusing on seniors with hypertension and dementia, whereas previous research often involved “relatively healthier older adults.”

Michelle Odden, one of the study’s main authors, told The Epoch Times she suspected that deprescribing residents from the medications may have improved blood flow to the brain, thereby improving cognition.

“There is some evidence that people with vascular disease in their brain may have trouble maintaining adequate blood flow in their brains,” Odden, associate professor in Stanford University’s Epidemiology and Population Health Department, said.

A previous study she led, published in 2019 in the Journal of Hypertension found that elevated blood pressure was associated with decreased cognitive scores among functioning older adults.

Other Medication Risks

Hypertension medications pose risks beyond potential cognitive effects.

“While antihypertensive medications reduce cardiovascular risks, they also pose risks of adverse effects such as falls, orthostatic hypotension, and drug-drug interactions,” the researchers reported. Orthostatic hypotension is characterized by a drop in blood pressure when standing up.

A 2023 study cited by these researchers highlighted the uncertainty surrounding optimal blood pressure control through medication in nursing homes, largely due to this population’s exclusion from clinical trials. The 2023 study, which shared some authors with the current research, found that more than 76 percent of residents in a VA nursing home were receiving hypertension medications, with 20 percent taking three or more such medications.

Conflicting Research Findings

Research evaluating how blood pressure medications affect cognition has produced mixed findings.

A recently published review suggested that some blood pressure medications might reduce the risk of cognitive decline.

This analysis, based on data from 14 studies involving more than 31,000 adults aged 60 and older, indicated a higher risk of developing Alzheimer’s disease among those not treated with medications.

The studies, which included participants from several nations, including the United States, Brazil, and China, had an average follow-up period of four years.

Seniors Require Personal Treatment

Odden explained that physicians should practice this “patient-centered” approach through personal communication.

“It is important that patients discuss goals of care with older adults, especially those with limited life expectancy,” Odden said. “Antihypertensive medications have many important benefits, but in some older adults, the benefits may not outweigh the potential harms.”

“This work highlights the need for patient-centered approaches to deprescribing, ensuring that medication regimens for older adults are optimized to preserve cognitive function and minimize potential harms,” the researchers reported.