Angiotensin receptor blockers reduce dementia progression in hypertensive patients: AHA

China: A new study published in the journal Hypertension showed that angiotensin receptor blockers were related to a decreased risk of dementia development in adults with hypertension and moderate cognitive impairment when compared to angiotensin-converting enzyme (ACE) inhibitors and other kinds of antihypertensive medications (AHMs).

Previous research revealed that hypertension drugs that affect the renin-angiotensin system may slow the progression from moderate cognitive impairment to dementia. It is unknown, however, if this relationship differs across angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. The angiotensin hypothesis, which proposes that the renin-angiotensin system has a role in brain function, was recently presented. Medications that boost angiotensin-mediated activity at the angiotensin II and IV receptors (e.g., ARBs) may give superior brain protection to those that decrease activity at these receptors (eg, ACE inhibitors)

Zhenhong Deng conducted a retrospective cohort analysis in the Alzheimer's Disease Neuroimaging Initiative with 403 individuals who had baseline hypertension and mild cognitive impairment. Angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium channel blockers, and diuretics were among the AHMs identified throughout the follow-up period. In the time to event analysis, Cox proportional hazards models adjusted for relevant confounders were applied, with dementia progression as the outcome.

The key findings of this study were as follows:

1. The mean age of the 403 participants was 74.0 years, 152 (37.7%) were female, and 158 (39.2%) developed dementia over a median follow-up duration of 3.0 years.

2. Angiotensin-converting enzyme inhibitors (ACE inhibitors), other types of AHMs (beta-blockers, diuretics, calcium channel blockers; adjusted hazard ratio, 0.49), and none of AHMs (adjusted hazard ratio, 0.31).

In conclusion, the findings of this study may have substantial therapeutic consequences, although they still demand additional research in bigger prospective cohorts or clinical trials.

Reference:

Deng, Z., Jiang, J., Wang, J., Pan, D., Zhu, Y., Li, H., Zhang, X., Liu, X., Xu, Y., Li, Y., Tang, Y., & Alzheimer's Disease Neuroimaging Initiative†. (2022). Angiotensin receptor blockers are associated with a lower risk of progression from mild cognitive impairment to dementia. Hypertension. https://doi.org/10.1161/HYPERTENSIONAHA.122.19378