Factors associated with angiotensin II stimulating vs. inhibiting antihypertensive drug use in older adults

Limited understanding exists regarding factors associated with use of angiotensin II–inhibiting drugs (AIDs) vs. angiotensin II–stimulating drugs (ASDs), antihypertensive treatments increasingly studied for potential neuroprotective effects. This study utilised both survey and claims data to examine factors associated with ASD vs. AID use. This retrospective cohort study was conducted with data from Health and Retirement Study (HRS) participants aged ≥ 65 years who had hypertension and consented to link their Medicare data from 2006 to 2020. Modified Poisson regression models were used to analyse factors associated with use of ASDs, AIDs, or a mix of both drugs. Of 4624 identified HRS-Medicare participants, 23. 8% used ASDs, 38. 6% used AIDs, and 37. 6% had mixed use of ASDs and AIDs. Patients with ASD use (vs. AID use) and patients with mixed use (vs. AID use) were more likely to be female and Black, and were less likely to have heart conditions. Other factors associated with ASD use (vs. AID use) included having a household income >50 000 USD and being less likely to have any hospitalisation, or emergency department visit. Other unique factors associated with mixed use (vs. AID use) included being obese or overweight, undergoing cholesterol screening, experiencing stroke, receiving ≥ 5 medications other than the studied CNS drugs, and having no use of anticholinergic drugs. This retrospective cohort study of older adults aged ≥ 65 years found several individual-level factors associated with the use of ASDs and mixed use of ASDs and AIDs, compared with AID use only. Our findings highlight the importance of accounting for these factors in investigations of neuroprotective outcomes related to the use of antihypertensive drugs.