Prescribing trends and time series analysis of blood pressure-lowering drugs among patients with dementia: a multinational database study

EClinicalMedicine. 2025 Oct 30;90:103595. doi: 10.1016/j.eclinm.2025.103595. eCollection 2025 Dec.

ABSTRACT

BACKGROUND: Hypertension is common among people living with dementia and blood pressure-lowering drug (BPLD) treatment in dementia patients may vary widely between individuals and countries/regions. This study aimed to describe and evaluate how prescribing trends of BPLD change before and after incident dementia diagnosis using electronic health record databases across four countries/regions.

METHODS: Electronic health records were collected from Hong Kong, United Kingdom, Sweden, and Australia for this study. Study dates were based on data availability from each database and ranged from January 1st, 2000 to December 31st, 2020. The target population were people diagnosed with dementia, with a prior diagnosis of hypertension and prescription of BPLD. Time series analysis, similar to interrupted time series, was conducted to evaluate the prescribing trends of BPLD three years before and after dementia diagnosis. The primary outcome of interest was the monthly proportion of patients prescribed with a BPLD.

FINDINGS: 31,873 patients from Hong Kong, 59,108 from the UK, 5034 from Sweden and 12,807 from Australia were included in this study. The mean age ranged from 78.3 years in Australia to 81.1 years in Hong Kong at time series entry. BPLD prescribing decreased in the three years before dementia diagnosis (negative pre-dementia slope) across all four databases. A significant immediate increase in antihypertensive prescribing was observed immediately after incident dementia diagnosis in Hong Kong (Estimate∗100: 4.66, 95% CI: 3.79-5.53), Sweden (Estimate∗100: 2.24, 95% CI: 1.60-2.88), and Australia (Estimate∗100: 1.58, 95% CI: 1.07-2.09), while there was no significant level change in the UK. BPLD prescribing declined in the three years after diagnosis for all databases.

INTERPRETATION: This is the largest multinational population-based study to date investigating prescribing trends of BPLD before and after dementia diagnosis. The time series analysis results suggested that there was increased vigilance of blood pressure control shortly after dementia diagnosis.

FUNDING: This study was supported by the Hong Kong Research Grants Council General Research Fund, No. 17113720.

PMID:41245536 | PMC:PMC12613062 | DOI:10.1016/j.eclinm.2025.103595