BACKGROUND: Hypertension (HTN) is a risk factor for dementia, and animal studies suggest that centrally active angiotensin-converting enzyme (ACE) inhibitors (those that cross the blood-brain barrier) may protect against dementia beyond HTN control. METHODS: Participants in the Cardiovascular Health Study Cognition Substudy with treated HTN and no diagnosis of congestive heart failure (n = 1054; mean age, 75 years) were followed up for a median of 6 years to determine whether cumulative exposure to ACE inhibitors (as a class and by central activity), compared with other anti-HTN agents, was associated with a lower risk of incident dementia, cognitive decline (by Modified Mini-Mental State Examination [3MSE]), or incident disability in instrumental activities of daily living (IADLs). RESULTS: Among 414 participants who were exposed to ACE inhibitors and 640 who were not, there were 158 cases of incident dementia. Compared with other anti-HTN drugs, there was no association between exposure to all ACE inhibitors and risk of dementia (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.88-1.15), difference in 3MSE scores (-0.32 points per year; P = .15), or odds of disability in IADLs (odds ratio [OR], 1.06; 95% CI, 0.99-1.14). Adjusted results were similar. However, centrally active ACE inhibitors were associated with 65% less decline in 3MSE scores per year of exposure (P = .01), and noncentrally active ACE inhibitors were associated with a greater risk of incident dementia (adjusted HR, 1.20; 95% CI, 1.00-1.43 per year of exposure) and greater odds of disability in IADLs (adjusted OR, 1.16; 95% CI, 1.03-1.30 per year of exposure) compared with other anti-HTN drugs. CONCLUSIONS: While ACE inhibitors as a class do not appear to be independently associated with dementia risk or cognitive decline in older hypertensive adults, there may be within-class differences in regard to these outcomes. These results should be confirmed with a randomized clinical trial of a centrally active ACE inhibitor in the prevention of cognitive decline and dementia.
BACKGROUND: Hypertension (HTN) is a risk factor for dementia, and animal studies suggest that centrally active angiotensin-converting enzyme (ACE) inhibitors (those that cross the blood-brain barrier) may protect against dementia beyond HTN control. METHODS: Participants in the Cardiovascular Health Study Cognition Substudy with treated HTN and no diagnosis of congestive heart failure (n = 1054; mean age, 75 years) were followed up for a median of 6 years to determine whether cumulative exposure to ACE inhibitors (as a class and by central activity), compared with other anti-HTN agents, was associated with a lower risk of incident dementia, cognitive decline (by Modified Mini-Mental State Examination [3MSE]), or incident disability in instrumental activities of daily living (IADLs). RESULTS: Among 414 participants who were exposed to ACE inhibitors and 640 who were not, there were 158 cases of incident dementia. Compared with other anti-HTN drugs, there was no association between exposure to all ACE inhibitors and risk of dementia (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.88-1.15), difference in 3MSE scores (-0.32 points per year; P = .15), or odds of disability in IADLs (odds ratio [OR], 1.06; 95% CI, 0.99-1.14). Adjusted results were similar. However, centrally active ACE inhibitors were associated with 65% less decline in 3MSE scores per year of exposure (P = .01), and noncentrally active ACE inhibitors were associated with a greater risk of incident dementia (adjusted HR, 1.20; 95% CI, 1.00-1.43 per year of exposure) and greater odds of disability in IADLs (adjusted OR, 1.16; 95% CI, 1.03-1.30 per year of exposure) compared with other anti-HTN drugs. CONCLUSIONS: While ACE inhibitors as a class do not appear to be independently associated with dementia risk or cognitive decline in older hypertensive adults, there may be within-class differences in regard to these outcomes. These results should be confirmed with a randomized clinical trial of a centrally active ACE inhibitor in the prevention of cognitive decline and dementia.
Authors: Françoise Forette; Marie-Laure Seux; Jan A Staessen; Lutgarde Thijs; Marija-Ruta Babarskiene; Speranta Babeanu; Alfredo Bossini; Robert Fagard; Blas Gil-Extremera; Tovio Laks; Zhanna Kobalava; Cinzia Sarti; Jaakko Tuomilehto; Hannu Vanhanen; John Webster; Yair Yodfat; Willem H Birkenhäger Journal: Arch Intern Med Date: 2002-10-14
Authors: Jason J Corneveaux; Amanda J Myers; April N Allen; Jeremy J Pruzin; Manuel Ramirez; Anzhelika Engel; Michael A Nalls; Kewei Chen; Wendy Lee; Kendria Chewning; Stephen E Villa; Hunsar B Meechoovet; Jill D Gerber; Danielle Frost; Hollie L Benson; Sean O'Reilly; Lori B Chibnik; Joshua M Shulman; Andrew B Singleton; David W Craig; Kendall R Van Keuren-Jensen; Travis Dunckley; David A Bennett; Philip L De Jager; Christopher Heward; John Hardy; Eric M Reiman; Matthew J Huentelman Journal: Hum Mol Genet Date: 2010-06-09 Impact factor: 6.150
Authors: Whitney Wharton; James H Stein; Claudia Korcarz; Jane Sachs; Sandra R Olson; Henrik Zetterberg; Maritza Dowling; Shuyun Ye; Carey E Gleason; Gail Underbakke; Laura E Jacobson; Sterling C Johnson; Mark A Sager; Sanjay Asthana; Cynthia M Carlsson Journal: J Alzheimers Dis Date: 2012 Impact factor: 4.472
Authors: Linda Ferrington; Laura E Palmer; Seth Love; Karen J Horsburgh; Paul At Kelly; Patrick G Kehoe Journal: Am J Transl Res Date: 2012-04-12 Impact factor: 4.060