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A Longitudinal Analysis of a Community-Based Sample of African Americans

Michael D. Murray, PharmD, MPH; Kathleen A. Lane, MS; Sujuan Gao, PhD; Rebecca M. Evans, MD; Frederick W. Unverzagt, MD; Kathleen S. Hall, PhD; Hugh Hendrie, MB, ChB

Arch Intern Med. 2002;162:2090-2096.

Background  Results of previous studies of white older adults suggest that antihypertensive medications preserve cognition. We assessed the long-term effect of antihypertensive medications on cognitive function in a community sample of African American older adults.

Methods  We conducted longitudinal surveys and clinical assessment of cognitive function in a random sample of 2212 community-dwelling African Americans 65 years and older. We identified 1900 participants without evidence of cognitive impairment at baseline, 1617 of whom had subsequent follow-up information, and 946 of whom had blood pressure measurements. Cognitive function was measured at baseline and at 2 and 5 years by means of scores on the Community Screening Instrument for Dementia and neuropsychological and clinical assessment for dementia and cognitive impairment. Prescription and nonprescription medication use was derived from in-home inspection of medications and participant and informant reports.

Results  Of 1900 participants, 288 (15.2%) developed incident cognitive impairment. Using logistic regression to control for the effects of age, sex, education, baseline cognitive scores, and hypertension and angina or myocardial infarction, we found that antihypertensive medications reduced the odds of incident cognitive impairment by 38% (odds ratio, 0.62; 95% confidence interval, 0.45-0.84). Corresponding analysis using blood pressure measurements on the subset of participants was inconclusive.

Conclusion  Antihypertensive medication use is associated with preservation of cognitive function in older African American adults.

From the Departments of Psychiatry (Drs Evans, Unverzagt, Hall, and Hendrie) and Medicine (Drs Murray and Gao and Ms Lane), Indiana University School of Medicine, Department of Pharmacy Practice, Purdue University School of Pharmacy (Dr Murray), and Regenstrief Institute for Health Care (Drs Murray and Hendrie), Indianapolis, Ind.

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