Stopping blood pressure medication may improve cognitive function

A new study published in JAMA Internal Medicine finds that stopping blood pressure medication may slow cognitive decline in older adults, especially those with dementia.

The study, which included more than 12,000 participants, challenges previous assumptions about the treatment of hypertension in older adults and sparks discussions about the optimal medication management for people in long-term care settings.

“Our findings … remind physicians to be cautious in initiating aggressive blood pressure control in older adults living in nursing homes, especially those with cognitive impairment,” the authors wrote.

Researchers have linked high blood pressure medications to the problem of overmedication among older adults. About half of older adults are taking five or more medications, which can lead to a variety of health problems. Antihypertensive drugs are the main driver of polypharmacy, accounting for 70% of all prescriptions for high blood pressure medications among older adults.

Measurable progress with fewer drugs

Patients who stopped taking antihypertensive medications had a 16% lower risk of cognitive decline.

The study, conducted by researchers at the University of California, San Francisco, Stanford University and the Veterans Affairs Medical Center, involved more than 12,000 nursing home residents and aimed to examine the link between blood pressure medication and cognitive decline. All participants had some degree of cognitive impairment.

The study, which was conducted over 13 years in Veterans Administration long-term care facilities, involved participants who stayed in the facilities for at least 12 weeks. It was funded by the National Institute on Aging.

The authors said: “Our study suggests that reducing the use of antihypertensive medications may help avoid future cognitive decline in nursing home residents, especially for those with dementia.”

“In midlife, elevated blood pressure (BP) is recognized as an important risk factor for cognitive decline, but optimal BP targets remain unclear for older adults, especially those living in nursing homes.”

Previous clinical trials have produced mixed results on the effects of blood pressure-lowering drugs on reducing cognitive decline. The authors say their study differs from others in that it focused on older adults with both hypertension and dementia, whereas previous studies have typically involved “relatively healthy older adults.”

Michelle Odden, one of the lead authors of the study, told The Epoch Times that she believes stopping the medications from being given to residents may have improved blood flow to the brain, leading to better cognition.

“There is some evidence that people with cerebrovascular disease may have difficulty maintaining adequate blood flow to the brain,” said Oden, an associate professor in the Department of Epidemiology and Population Health at Stanford University.

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

Other risks of medication

The risks of high blood pressure medications are not limited to potential cognitive effects.

“Although blood pressure-lowering drugs can reduce cardiovascular risk, they may also be associated with adverse effects such as falls, orthostatic hypotension, and drug-drug interactions,” the researchers noted.

Orthostatic hypotension is a drop in blood pressure when you stand up.

The researchers cited a 2023 study, co-authored in part with the current study, that found more than 76% of residents in Veterans Administration nursing homes were taking medication for high blood pressure, with 20% taking three or more high blood pressure medications.

Conflicting research results

It is not uncommon for researchers to find different results depending on the study parameters. Studies of the effects of high blood pressure medications on cognition have also yielded mixed results.

Certain blood pressure medications may help reduce the risk of cognitive decline, suggests a recently published review of studies.

The review, which analyzed data from 14 studies involving more than 31,000 adults aged 60 and older, showed that people who did not receive blood pressure medication had a higher risk of developing Alzheimer’s disease.

Participants in these studies came from multiple countries, including the United States, Brazil and China, and were followed for an average of four years.

Older people need personalized care

Doctors should communicate on an individual basis, taking a “patient-centered” approach to best assist patients in coping with health issues, Oden said.

“It is very important to discuss goals of care with older patients, especially for those with limited life expectancy,” Oden said. “Antihypertensive medications have many important benefits, but for some older adults, these benefits may not outweigh the potential risks.”

The researchers noted, “This study highlights the need for a patient-centered approach to medication reduction to ensure that older adults’ medication regimens are optimized to protect cognitive function and minimize potential harms.”