Racial and ethnic differences in the risk of dementia diagnosis under hypothetical blood pressure–lowering interventions: The Multi‐Ethnic Study of Atherosclerosis

INTRODUCTION Substantial racial and ethnic disparities in hypertension and dementia exist in the United States. We evaluated the effect of maintaining systolic blood pressure (SBP) below clinical thresholds on dementia incidence. METHODS We included 6806 Multi‐Ethnic Study of Atherosclerosis participants (44 to 84 years old). We implemented the parametric g‐formula to simulate the hypothetical interventions to reduce SBP below 120 and 140 mmHg over time, accounting for time‐varying confounding. We estimated risk ratios (RRs) and risk differences for dementia incidence at 19 years. RESULTS The RRs (95% confidence intervals [CIs]) comparing an intervention reducing SBP below 120 mmHg to no intervention were 0.93 (0.87 to 0.99) for total sample, 0.95 (0.88 to 1.02) for White, 0.90 (0.79 to 1.02) for Black, 0.90 (0.78 to 1.05) for Latino, and 1.16 (0.83 to 1.55) for Chinese American participants. Results for lowering SBP below 140 mmHg and with death as competing event were attenuated. DISCUSSION The reduction of SBP below 120 mmHg over time has modest effects on reducing dementia incidence. More work is needed to understand the heterogeneity across racial and ethnic groups. Highlights There is a potential beneficial effect in lowering SBP to reduce the risk of dementia, which may vary by race and ethnicity. The percentage of participants who would need intervention on blood pressure to meet clinical thresholds is greater for Black and Latino communities. Results are sensitive to the way that death is specified in the research question and analysis.