Cardiovascular drug use and Alzheimer’s disease: A systematic review of clinical evidence

Background Alzheimer’s disease (AD), the most prevalent form of dementia, is increasingly recognized as a multifactorial condition involving both neurodegenerative and vascular components. Cardiovascular disease (CVD) and its pharmacologic management may influence the onset or progression of AD, but the cognitive effects of commonly prescribed cardiovascular drugs remain uncertain. Objective To systematically review and synthesize clinical evidence on the relationship between cardiovascular drug use and Alzheimer’s disease risk, focusing on specific drug classes, usage patterns, and patient characteristics. Methods A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language studies published up to May 2025. Studies were included if they reported on adult patients using cardiovascular drugs with subsequent diagnosis or progression of AD. Eligible designs included randomized controlled trials (RCTs), cohort studies, case-control studies, and case reports/series. Data extraction and quality assessment were performed using Joanna Briggs Institute (JBI) tools. Results Antihypertensive drugs such as ARBs and beta-blockers were associated with reduced dementia risk in some populations, though overly aggressive blood pressure control in the elderly appeared harmful. Statin use showed mixed results, with possible benefits in high-risk groups and potential adverse effects in individual cases. Calcium channel blockers and ARNIs demonstrated possible cognitive benefits, while beta-blockers and ACE inhibitors showed variable results depending on the context. Conclusion Cardiovascular drugs may influence cognitive outcomes in complex and context-dependent ways. Personalized prescribing strategies and further high-quality research are essential to optimize cognitive protection in patients at risk for AD.