Hypothetical blood-pressure-lowering interventions and risk of stroke and dementia
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NEURO-EPIDEMIOLOGY
Hypothetical blood‑pressure‑lowering interventions and risk of stroke and dementia Liliana Paloma Rojas‑Saunero1 · Saima Hilal1,2,3 · Eleanor J. Murray4,5 · Roger W. Logan4 · Mohammad Arfan Ikram1 · Sonja A. Swanson1,4 Received: 3 June 2020 / Accepted: 7 November 2020 © The Author(s) 2020
Abstract We aimed to study the effects of hypothetical interventions on systolic blood pressure (SBP) and smoking on risk of stroke and dementia using data from 15 years of follow-up in the Rotterdam Study. We used data from 4930 individuals, aged 55–80 years, with no prior history of stroke, dementia or cognitive impairment, followed for 15 years within the Rotterdam Study, a population-based cohort. We defined the following sustained interventions on SBP: (1) maintaining SBP below 120 mmHg, (2) maintaining SBP below 140 mmHg, (3) reducing SBP by 10% if above 140 mmHg, (4) reducing SBP by 20% if above 140 mmHg, and a combined intervention of quitting smoking with each of these SBP-lowering strategies. We considered incident stroke and incident dementia diagnoses as outcomes. We applied the parametric g-formula to adjust for baseline and time-varying confounding. The observed 15-year risk for stroke was 10.7%. Compared to no specified intervention (i.e., the “natural course”), all interventions that involved reducing SBP were associated with a stroke risk reduction of about 10% (e.g., reducing SBP by 20% if above 140 mmHg risk ratio: 0.89; 95% CI 0.76, 1). Jointly intervening on SBP and smoking status further decreased the risk of stroke (e.g., risk ratio: 0.83; 95% CI 0.71, 0.94). None of the specified interventions were associated with a substantive change in dementia risk. Our study suggests that a joint intervention on SBP and smoking cessation during later life may reduce stroke risk, while the potential for reducing dementia risk were not observed. Keywords Hypertension · Dementia · Stroke · Target trial · g-Formula
Liliana Paloma Rojas-Saunero and Saima Hilal have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10654-020-00694-5) contains supplementary material, which is available to authorized users. A Spanish version of the manuscript is provided as supplementary material. * Liliana Paloma Rojas‑Saunero [email protected] 1
Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
2
Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
3
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
4
Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
5
Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
Introduction The increase in life expectancy over the past decades has profound implications on the occurrence of diseases. As a result of th
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