Key result
Use of ATII-stimulating antihypertensives was non-significantly associated with a 20% lower risk of incident dementia (HR 0.80) over 10.4 years compared to other antihypertensive classes.
Why the study?
Prior studies linking angiotensin II-stimulating antihypertensive medications with lower dementia risk had relatively short follow-up periods, leaving it unclear if these effects are sustained over longer durations.
Does the use of ATII-stimulating antihypertensives, ARBs, or dihydropyridine CCBs reduce incident dementia in older adults on antihypertensive therapy?
Observational (n=1,907)
Yes
Does the use of ATII-stimulating antihypertensives, ARBs, or dihydropyridine CCBs reduce incident dementia in older adults on antihypertensive therapy?
The use of ARBs, dihydropyridine CCBs, and ATII-stimulating antihypertensives is associated with a lower risk of dementia over a decade, although the protective associations attenuate over time.
May inform AHM selection in dementia-prone patients; extends short-term observations to a decade yet remains hypothesis-generating.
INTRODUCTION: Use of angiotensin II (ATII)-stimulating antihypertensive medication (AHM), including angiotensin receptor blockers (ARBs) and dihydropyridine calcium channel blockers (CCBs), has been associated with lower dementia risk. Previous studies had relatively short follow-up periods. The aim of this study is to investigate if these effects are sustained over longer periods. METHODS: This post hoc observational analysis was based on data from a dementia prevention trial (preDIVA and its observational extension), among Dutch community-dwelling older adults without prior diagnosis of dementia. Differential associations between AHM classes and incident dementia were studied after 7.0 and 10.4 years, based on the median follow-up durations of dementia cases and all participants. RESULTS: After 7 years, use of ATII-stimulating antihypertensives [hazard ratio = 0.68, 95% confidence interval (CI) = 0.47-1.00], ARBs (hazard ratio = 0.54, 95% CI = 0.31-0.94) and dihydropyridine CCBs (hazard ratio = 0.52, 95% CI = 0.30-0.91) was associated with lower dementia risk. After 10.4 years, associations for ATII-stimulating antihypertensives, ARBs and dihydropyridine CCBs attenuated (hazard ratio = 0.80, 95% CI = 0.61-1.04; hazard ratio = 0.75, 95% CI = 0.53-1.07; hazard ratio = 0.73, 95% CI = 0.51-1.04 respectively), but still suggested lower dementia risk when compared with use of other AHM classes. Results could not be explained by competing risk of mortality. CONCLUSION: Our results suggest that use of ARBs, dihydropyridine CCBs and ATII-stimulating antihypertensives is associated with lower dementia risk over a decade, although associations attenuate over time. Apart from methodological aspects, differential effects of antihypertensive medication classes on incident dementia may in part be temporary, or decrease with ageing.
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Schroevers et al. (2022) conducted an observational in Dementia (n=1,907). ATII-stimulating antihypertensive medication vs. Other antihypertensive medication classes was evaluated on Incident dementia (HR 0.80, 95% CI 0.61-1.04). Use of ATII-stimulating antihypertensives was non-significantly associated with a 20% lower risk of incident dementia (HR 0.80) over 10.4 years compared to other antihypertensive classes.
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