P4‐263: Angiotensin receptors blockers could be associated with a lower MMSE score decline in hypertensive patients with Alzheimer's disease

Many factors may influence Alzheimer's disease (AD) progression including antihypertensive drugs. This study aimed to compare the cognitive decline in patients with AD treated with different pharmacological classes of antihypertensive treatments. Standardized medical records of patients with AD and high blood pressure, referred to the memory clinic in 2007 and followed-up for at least 2 years, were reviewed especially for prescriptions for antihypertensive drugs and MMSE scores. Patients who changed their anti-hypertensive treatment during the 2-year follow-up were excluded. Linear mixed models with time-randomized effect were used to analyze MMSE decline. Models have been adjusted for age, gender, education levels, and cardiovascular history. One hundred and eighty-five AD-patients (85 [46%] women, mean age 77.2 ± 7.9 years) treated with antihypertensive drugs were followed between 2007 and 2009;112 patients (61%) were treated with only one anti hypertensive drugs, 55 patients (30%) with two drugs, and 17 (9%) with three. The antihypertensive classes were beta-blockers (34.3%), angiotensin receptors blockers (33.5%), diuretics (29.2%), ACE inhibitors (28.1%), calcium channel blockers (20%), and centrally acting drugs (8.1%). Mean MMSE score at entry was 19.04 ± 5.72. The groups did not differ significantly for the associated anti-Alzheimer treatments. The mean annual MMSE score decline was 1.58 points ± 1.40 in patients treated with beta blockers, 1.33 points ± 1.55 in those treated with angiotensin receptors blockers, 1,41 points ± 1.48 with diuretics, 1.61 points ± 1.52 with ACE inhibitors, 1.63 points ± 1.64 with calcium channel blockers, and 2 points ± 1.57 with centrally acting drugs. The analysis did not show any statistically significant difference between antihypertensive classes, however patients treated with angiotensin receptors blockers had a mean annual MMSE decline 0.48 points lower than patients treated with other antihypertensive drugs in the adjusted mixed models. In this observational study, patients with AD and high blood pressure treated with angiotensin receptors blockers seemed to have a lower cognitive decline than those treated with other antihypertensive drugs. If this is confirmed by longer, more powerful randomised studies, it could be the first line class to be used in patients with AD and high blood pressure.