EFFECT OF HYPERTENSION CONTROL ON ALZHEIMER’S DISEASE AND RELATED DEMENTIAS

Abstract

Alzheimer’s Disease and Related Dementias (ADRD) represent a critical public health challenge, exacerbated by an aging population and rising healthcare demands. Yet, recent data remain limited regarding ADRD prevalence trends overall and by subtypes, as well as ADRD characteristics in high-risk populations, including African Americans, Hispanics, individuals with hypertension (HTN), and those experiencing social disadvantages. Furthermore, although HTN is widely recognized as a modifiable risk factor for ADRD, there is a lack of evidence on the differential impacts of HTN control levels, particularly apparent treatment-resistant hypertension (aTRH), on ADRD development and associated cardiovascular outcomes. This dissertation addresses these gaps through three interconnected aims using electronic health record data from the OneFlorida Data Trust (2012–2022). Aim 1 characterized ADRD prevalence trends overall and by subtypes, and identified characteristics in high-risk populations. Among 106,874 ADRD patients, ADRD prevalence increased over the last decade, with variability observed across subtypes. Unspecified dementia was the predominant subtype (72%). HTN, diabetes, stroke, high social deprivation, female sex, and peripheral artery disease emerged as prominent ADRD characteristics in high-risk groups. Aim 2 evaluated the effect of different HTN control levels on cardiovascular outcomes in 9,430 ADRD patients. Compared to ADRD patients without HTN, those with uncontrolled HTN showed the highest cardiovascular risk (HR: 1.97, 95% CI: 1.54–2.51), followed by patients with well-controlled HTN (HR: 1.53, 95% CI: 1.22–1.93), intermediate-controlled HTN (HR: 1.49, 95% CI: 1.16–1.90), and aTRH (HR: 1.30, 95% CI: 1.04–1.63). Aim 3 assessed how HTN control levels and social deprivation influence ADRD development within a cohort of 57,273 HTN patients. Compared to well-controlled HTN, aTRH significantly increased ADRD risk (HR: 1.16, 95% CI: 1.09–1.24). Additionally, higher levels of social deprivation were associated with increased ADRD risk. In conclusion, this dissertation offers key insights by characterizing ADRD and its subtypes, analyzing prevalence trends, and identifying patient characteristics in high-risk populations. Our findings highlight the importance of effective blood pressure control in reducing cardiovascular events among ADRD patients and lowering the risk of ADRD development. Additionally, they highlight socioeconomic status as a critical factor influencing ADRD risk and informing prevention strategies.