OBJECTIVES : Cardiovascular disease (CVD) has been shown to be a risk factor for cognitive decline among patients with Alzheimer’s Disease (AD). In addition, treatments for CVD including antihypertensives may reduce cognitive decline among these patients. This study describes treatment patterns of antihypertensives among patients with AD in the United States (US) and France.

METHODS : Patients with AD and ≥ 2 years of continuous observation were selected from de-identified electronic medical records in the US between 1/1/2014 and 11/30/2018, and from France between 7/1/2016 to 6/30/2019. All data sets were converted into the OMOP Common Data Model v5. Treatment patterns of antihypertensive medications, including thiazide-type diuretics angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, were assessed and compared.

RESULTS : In the US population, 45.4% of patients had ≥ 1 record for an antihypertensive; among these patients, 30.1% were adherent over 1-year. Among the patients without evidence of antihypertensive use, 35.1% had a hypertension diagnosis. In the French population, 16.7% of patients had ≥ 1 record for an antihypertensive; among these patients, 71.9% were adherent over 1-year. Among the patients without evidence of antihypertensive use, 18.0% had a hypertension diagnosis.

CONCLUSIONS : In the US population, a majority of patients prescribed antihypertensives were non-adherent, while the opposite was true for the France population. In addition, the proportion of patients with hypertension diagnosis and with no evidence of antihypertensive use in the US was nearly twice the proportion of similar patients in France. These discrepancies may be explained by differences in medical practices and access to care. Further research is needed to identify modifiable characteristics associated with non-adherence which can improve hypertension-related outcomes and possibly cognitive decline in AD.