ACE inhibitors, compared to ARBs, were linked to reduced white matter integrity and altered brain functional connectivity in hypertensive patients (p≤0.049).
Does ACEi compared to ARBs improve cerebral microstructural and functional integrity in hypertensive patients?
In hypertensive patients, ACE inhibitors may be associated with worse cerebral microstructural and functional integrity compared to ARBs.
Absolute Event Rate: 0% vs 0%
Abstract Backround: Treating hypertension by RAAS-targeting drugs has beneficial effects on cardiovascular health, preventing major cardiovascular (CV) events like myocardial infarction (MI), stroke and global CV mortality either blocking the Angiotensin Receptor (ARBs) or inhibiting the Angiotensin Converting Enzyme activity (ACEi). Aim: With our study we want to investigate whether the two strategies targeting the RAAS have different effects on brain injury in hypertensive patients. Methods: We performed neuroimaging on MRI to characterize the microstructural integrity of the white matter and functional connectivity of the gray matter in hypertensives treated with ACEi or ARBs. We subjected 51 patients to Diffusion Tensor Imaging (DTI) and resting state functional MRI (rs-fMRI). DTI features were normalized to assess their correlation with the antihypertensive treatment by general linear model. Rs-fMRI functional connectivity was evaluated by cross-correlation of BOLD signal among different brain regions and analyzed by regression analysis to highlight differences in patients treated with ACEi or ARBs. Both models included regressors: age, sex, BMI, alcohol, smoke, SBP and DBP levels, heart rate. Results: DTI shows a correlation between ACEi and reduced integrity of the Anterior Commissure, a tract connecting the two hemispheres (MD: std beta=0.495, T=2.113, p=0.042, n=51; L2: std beta=0.482, T=2.105, p=0.042, n=51) and Right Temporal Cingulum, a tract implicated in executive functions (L1: std beta=0.392, T=2.036, p=0.049, n=51), while no tract integrity loss was associated with ARBs. Rs-fMRI shown that ACEi treatment is correlated with the modulation of connection between Default Mode Network and FrontoParietal Network, respectively associated to self-consciousness and executive functions (PCC to LPFC: F=1.51, T=4.14, p-FDR=0.0077), while no cerebral connections were associated with ARBs treatment. Conclusions: In conclusion, our data suggest that ACEi compared to ARBs have worse outcomes in terms of cerebral microstructural and functional integrity. Future studies with head-to-head comparison are needed to fully elucidate which RAAS targeting strategy is better suited for brain health, in particular in patients with elevated risk for cognitive impairment and dementia.
Carnevale et al. (Sat,) berichteten über ein anderes. ACE-Hemmer wurden im Vergleich zu ARBs mit einer verringerten Integrität der weißen Substanz und veränderter funktioneller Hirnvernetzung bei hypertonen Patienten in Verbindung gebracht (p≤0.049).