ARBs linked to lower AD pathology in autopsies; leaves open disease-modifying effects in living patients.
Key Points
To assess whether treatment with angiotensin receptor blockers is linked to reduced Alzheimer disease neuropathology in brain autopsies of hypertensive individuals.
Analyzed brain autopsy data from the National Alzheimer Coordinating Center across 29 centers in the United States, evaluating N = 890 hypertensive participants (mean age at death, 81 years; range, 39–107; 43% women; 94% white).
Employed multiple logistic regression models to evaluate neuritic plaques, neurofibrillary tangles, and vascular injury markers across users of ARBs, other antihypertensives, and untreated hypertensive individuals.
ARB treatment was associated with significantly lower odds of AD pathology compared with other antihypertensives: lower CERAD score (OR, 0.47; 95% CI, 0.27–0.81), lower ADRDA score (OR, 0.43; 95% CI, 0.21–0.91), lower Braak and Braak stage (OR, 0.52; 95% CI, 0.31–0.85), and fewer neuritic plaques (OR, 0.59; 95% CI, 0.37–0.96).
Participants receiving ARBs showed less overall AD-related neuropathology compared with untreated hypertensive individuals, but had higher rates of stroke and autopsy-confirmed large vessel infarcts and hemorrhage.