Key result
Telmisartan is linked to lower dementia risk versus ACEIs and other ARBs in hypertensive adults.
Why the study?
Whether telmisartan is associated with a reduced risk of dementia compared to other RAS inhibitors in patients with HTN and varying blood sugar levels remained unclear.
Does telmisartan reduce the risk of dementia and stroke compared to other RAS inhibitors in patients with hypertension?
Observational (n=39,665)
Yes
Does telmisartan reduce the risk of dementia and stroke compared to other RAS inhibitors in patients with hypertension?
Telmisartan may offer superior cognitive and cerebrovascular protection compared to other RAS inhibitors in hypertensive patients.
Answers are grounded in this paper and cite their sources.
Should not yet change ARB selection in hypertension; leaves open whether telmisartan confers dementia protection versus other RAS inhibitors.
INTRODUCTION The aim of this study was to investigate the cognitive and cerebrovascular outcomes of patients with hypertension (HTN) receiving various renin‐angiotensin system (RAS) inhibitors. METHODS We further categorized 39,665 patients with HTN receiving long‐term RAS inhibitor therapy into (1) telmisartan, (2) non‐telmisartan angiotensin receptor blocker (NT‐ARB), and (3) angiotensin‐converting enzyme inhibitor groups. The main outcomes were a diagnosis of all dementias and the occurrence of all strokes during follow‐up. RESULTS The telmisartan group had the lowest risk of all dementias (telmisartan vs NT‐ARB: hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.60 to 1.01; telmisartan vs angiotensin‐converting enzyme inhibitor: HR: 0.67; 95% CI: 0.48 to 0.94). The telmisartan group also had a lower risk of all strokes when compared to NT‐ARB (HR: 0.78; 95% CI: 0.61 to 0.99) in the time‐dependent cohort. DISCUSSION Use of telmisartan may be associated with marginally lower risks of all dementias and strokes compared to other RAS inhibitors in patients with HTN. Highlights Whether telmisartan is associated with a reduced risk of dementia compared to other RAS inhibitors in patients with HTN and varying blood sugar levels remains unclear. Our cohort study aimed to investigate the long‐term cognitive and cerebrovascular outcomes of hypertensive patients receiving telmisartan compared to those receiving other RAS inhibitors. Eligible individuals were categorized into three groups. Use of telmisartan may be associated with marginally lower risks of all dementia and stroke compared with other RAS inhibitors in patients with HTN.
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Liu et al. (2026) conducted an observational in East Asian Han Chinese adults with hypertension receiving long-term renin-angiotensin system inhibitor therapy, excluding those with dementia, traumatic brain injury, brain tumor or epilepsy, age ≥40 years (n=39,665). Telmisartan vs. Non-telmisartan angiotensin receptor blockers (NT-ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was evaluated on Diagnosis of all dementias (including Alzheimer's disease and non-Alzheimer's dementia) and occurrence of all strokes (ischemic stroke and intracranial hemorrhage) during follow-up (HR 0.78 (telmisartan vs NT-ARB), 95% CI 0.60 to 1.01, p=0.064). Telmisartan was associated with a 22% reduction in risk of all dementias compared to non-telmisartan ARBs and a 33% reduction compared with ACEIs in hypertensive East Asian adults.
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