{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:12:20Z","timestamp":1777396340368,"version":"3.51.4"},"reference-count":34,"publisher":"SAGE Publications","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAD"],"published-print":{"date-parts":[[2023,8,15]]},"abstract":"<jats:p>Background: Hypertension has been identified as a risk factor of dementia, but most randomized trials did not show efficacy in reducing the risk of dementia. Midlife hypertension may be a target for intervention, but it is infeasible to conduct a trial initiating antihypertensive medication from midlife till dementia occurs late life. Objective: We aimed to emulate a target trial to estimate the effectiveness of initiating antihypertensive medication from midlife on reducing incident dementia using observational data. Methods: The Health and Retirement Study from 1996 to 2018 was used to emulate a target trial among non-institutional dementia-free subjects aged 45 to 65 years. Dementia status was determined using algorithm based on cognitive tests. Individuals were assigned to initiating antihypertensive medication or not, based on the self-reported use of antihypertensive medication at baseline in 1996. Observational analog of intention-to-treat and per-protocol effects were conducted. Pooled logistic regression models with inverse-probability of treatment and censoring weighting using logistic regression models were applied, and risk ratios (RRs) were calculated, with 200 bootstrapping conducted for the 95% confidence intervals (CIs). Results: A total of 2,375 subjects were included in the analysis. After 22 years of follow-up, initiating antihypertensive medication reduced incident dementia by 22% (RR\u200a=\u200a0.78, 95% CI: 0.63, 0.99). No significant reduction of incident dementia was observed with sustained use of antihypertensive medication. Conclusion: Initiating antihypertensive medication from midlife may be beneficial for reducing incident dementia in late life. Future studies are warranted to estimate the effectiveness using large samples with improved clinical measurements.<\/jats:p>","DOI":"10.3233\/jad-230398","type":"journal-article","created":{"date-parts":[[2023,7,7]],"date-time":"2023-07-07T10:53:33Z","timestamp":1688727213000},"page":"1431-1441","source":"Crossref","is-referenced-by-count":6,"title":["Initiation of Antihypertensive Medication from Midlife on Incident Dementia: The Health and Retirement Study"],"prefix":"10.1177","volume":"94","author":[{"given":"Jingkai","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanzhang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, USA"},{"name":"School of Nursing, Duke University, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donglan","family":"Zhang","sequence":"additional","affiliation":[{"name":"New York University Langone Health, New York, NY, USA"},{"name":"Long Island School of Medicine, New York University, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huilin","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiansheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gilllings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan E.","family":"Steck","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmin","family":"Divers","sequence":"additional","affiliation":[{"name":"New York University Langone Health, New York, NY, USA"},{"name":"Long Island School of Medicine, New York University, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiajia","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anwar T.","family":"Merchant","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 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