Exposure to ACE inhibitors as a class was not associated with incident dementia compared with other antihypertensives (HR 1.01; 95% CI 0.88-1.15), though centrally active agents reduced cognitive decline.
Cohort (n=1,054)
Does cumulative exposure to ACE inhibitors reduce incident dementia and cognitive decline in older adults with treated hypertension compared to other anti-hypertensive agents?
While ACE inhibitors as a class do not reduce dementia risk compared to other antihypertensives, centrally active ACE inhibitors may slow cognitive decline in older adults with hypertension.
Hazard Ratio: 1.01 (95% CI 0.88–1.15)
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.
Sink et al. (Mon,) conducted a cohort in Hypertension (n=1,054). ACE inhibitors vs. Other anti-hypertensive agents was evaluated on Incident dementia (HR 1.01, 95% CI 0.88-1.15). Exposure to ACE inhibitors as a class was not associated with incident dementia compared with other antihypertensives (HR 1.01; 95% CI 0.88-1.15), though centrally active agents reduced cognitive decline.