Hypothetical blood-pressure-lowering interventions and risk of stroke and dementia

Liliana Paloma Rojas Saunero, Saima Hilal, EJ Murray, RW Logan, Arfan Ikram, Sonja Swanson

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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.

Original languageEnglish
Pages (from-to)69-79
Number of pages11
JournalEuropean Journal of Epidemiology
Issue number1
Publication statusPublished - 2021

Bibliographical note

Funding Information:
This study was partly funded by ZonMW Memorabel (Project Nr 73305095005) and Alzheimer Nederland through the Netherlands Consortium of Dementia Cohorts (NCDC) in the context of Deltaplan Dementie. Further funding was obtained from the Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation (CVON 2018-28 Heart Brain Connection Cross-roads), Dutch Federation of University Medical Centres, the Netherlands Organisation for Health Research and Development, the Royal Netherlands Academy of Sciences and DynaHEALTH Grant (European Union H2020-PHC-2014; 633595). Roger Logan had financial support from NIH Grant during the study period.

Publisher Copyright:
© 2020, The Author(s).

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  • EMC OR-01


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