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Blood pressure, antihypertensive medication and neuropsychiatric symptoms in persons with dementia: the COSMOS study

Blood pressure and neuropsychiatric symptoms

Bianca de Jong

De abstractcommissie heeft op verzoek van de congrescommissie negen abstracts geselecteerd die tijdens het Verenso najaarscongres 'Buitengewoon Bijzonder' op 28 november 2019 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.



Neuropsychiatric symptoms (NPS) are very common in older persons with dementia and clinical management is a challenge. The aetiology of NPS is multifactorial and here is increasing evidence that hypoperfusion of the brain plays a role in the development in NPS. As a consequence, blood pressure reduction in older people with impaired hemodynamic response may lead to hypoperfusion, resulting in increased mental health problems. In patients with dementia, the use of antihypertensive medication itself has been associated with increased occurrence of NPS. The underlying mechanism of the found associations is unclear.


To assess whether there is an association between low systolic blood pressure (SBP) and NPS in patients with dementia and if NPS in more prevalent in patients using antihypertensive medication.


We studied the baseline data from participants in the Communication, Systematic pain treatment, Medication review, Organized activities and Safety (COSMOS) study, a multicenter clustered randomized controlled trial with 765 participants from 72 nursing home units from 37 nursing homes in Norway. SBP (lowest quartile vs. rest) and use of antihypertensive medication were predictors; Neuropsychiatric Inventory – Nursing Home version (NPI-NH) score (total and clusters) as a measure of NPS was the outcome. Missing data were imputed, except for missing data in predictors. We used a mixed model analysis adjusted for age, sex and Minimal Mental State Examination (MMSE) score. In the sensitivity analysis, continuous SBP values were used.


In total 412 participants were included with a mean age of 86.9 (SD 7.4) years. The mean SBP was 128 mmHg (SD 21.5). 240 participants (53.3%) used antihypertensive treatment. Of all participants, 53.9% had a MMSE score of <11. There was no difference in total NPI-NH score between low and high SBP (difference -1.07, P-value 0.62). There was also no difference between high and low SBP in the scores of the NPI-clusters. The use of antihypertensive drugs was not associated with a different NPI-NH score compared to no use (difference -0.99, P-value 0.95), nor in the NPI-cluster score.


We found no association between low SBP and NPI-NH score, nor between antihypertensive use and NPI-NH score in nursing home residents with dementia. 



  • Drs. B.E.M de Jong – Schmit, aios ouderengeneeskunde, Public Health en Eerstelijnsgeneeskunde, Universiteit Leiden
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