Key result
ACE inhibitors show no benefit over other antihypertensives for incident dementia risk.
Why the study?
Does cumulative exposure to ACE inhibitors reduce the risk of incident dementia and cognitive decline compared to other anti-hypertensive agents in older adults with treated hypertension?
Cohort (n=1,054)
Yes
Does cumulative exposure to ACE inhibitors reduce the risk of incident dementia and cognitive decline compared to other anti-hypertensive agents in older adults with treated hypertension?
ACE inhibitors as a class do not appear to lower the risk of dementia more than other antihypertensive agents, but centrally active ACE inhibitors may slow cognitive decline.
ACE inhibitor choice should not prioritize dementia prevention; leaves open whether centrally active agents warrant prospective trials.
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.
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Sink et al. (2009) conducted a cohort in Hypertension (n=1,054). Angiotensin-converting enzyme (ACE) inhibitors vs. Other anti-hypertensive agents was evaluated on Incident, all-cause dementia (HR 1.01, 95% CI 0.88-1.15). Cumulative exposure to ACE inhibitors as a class was not associated with a lower risk of incident dementia compared to other anti-hypertensive drugs, though centrally active agents were associated with less cognitive decline.
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