Angiotensin receptor blockers may protect against dementia

January 01, 0001

Angiotensin receptor blockers may protect against dementia

These US authors examined whether angiotensin receptor blockers protect against dementia or reduce its progression. They performed a prosective cohort analysis using the administrative database of the US Veteran Affairs, yielding 819,491 predominantly male patient aged 65 or more with cardiovascular disease. Cox proportional hazard models with adjustments for age, diabetes, stroke, and cardiovascular disease were constructed were used for three cohorts- angiotensin receptor blockers, lisinopril, and other cardiovascular drugs (called the cardiovascular comparator by the authors).

The investigators found: "Hazard rates for incident dementia in the angiotensin receptor blocker group were 0.76 compared with the cardiovascular comparator and 0.81 compared with the lisinopril group. Compared with the cardiovascular comparator, angiotensin receptor blockers in patients with pre- existing Alzheimer’s disease were associated with a significantly lower risk of admission to a nursing home (0.51) and death (0.83). Angiotensin receptor blockers exhibited a dose-response as well as additive effects in combination with angiotensin converting enzyme inhibitors. This combination compared with angiotensin converting enzyme inhibitors alone was associated with a reduced risk of incident dementia (0.54) and admission to a nursing home (0.33). Minor differences were shown in mean systolic and diastolic blood pressures between the groups. Similar results were observed for Alzheimer’s disease."

The investigators concluded: "Angiotensin receptor blockers are associated with a significant reduction in the incidence and progression of Alzheimer’s disease and dementia compared with angiotensin converting enzyme inhibitors or other cardiovascular drugs in a predominantly male population."

This observational study finds promise of benefit for angiotensin receptor blockers in preventing depression in males, but confirmation and broader applicability remain to be seen.

For the full abstract, click here.

BMJ 340(121):b5465, 16 January 2010
© 2010 Li et al.
Use of angiotensin receptor blockers and risk of dementia in a predominantly male population- prospective cohort analysis. Nien-Chen Li, Austin Lee, Rachel A Whitmer, et al. Correspondence to Benjamin Wolozin: [email protected]

Category: N. Neurological. Keywords: angiotensin receptor blockers, dementia, Alzheimer’s, risk, progression, prospective cohort, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 3 February 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.