Key result
ARBs linked to ~8% lower all-cause dementia risk vs. CCBs in older adults.
Why the study?
It remains uncertain whether antihypertensive drug class influences dementia risk beyond blood pressure lowering.
Does initiation of an ARB-based regimen reduce the risk of incident dementia compared to a CCB-based regimen in dementia-free older adults with hypertension?
Cohort (n=52,019)
Yes
Does initiation of an ARB-based regimen reduce the risk of incident dementia compared to a CCB-based regimen in dementia-free older adults with hypertension?
In older adults with hypertension, initiating an ARB-based regimen is associated with a modestly lower risk of incident all-cause and vascular dementia compared to a CCB-based regimen, independent of blood pressure control.
May support ARB preference over CCBs in older hypertensives; hypothesis-generating and requires RCTs before practice change.
INTRODUCTION: Whether antihypertensive drug class influences dementia risk beyond blood pressure lowering remains uncertain. METHODS: We emulated a target trial comparing new initiation of angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) among dementia-free adults aged ≥65 years in a nationwide Japanese database. Weighted discrete-time hazards models estimated intention-to-treat and per-protocol effects, accounting for censoring and death. RESULTS: Among 52,019 eligible new users followed for a median of 3.6 years, 3524 incident dementia events occurred. ARB initiation was associated with lower all-cause dementia risk than CCB initiation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.852-0.985), with similar achieved blood pressure. For Alzheimer's disease (2231 events), the association was not statistically significant (HR, 0.930; 95% CI, 0.849-1.018). The association was stronger for vascular dementia (129 events; HR, 0.617; 95% CI, 0.409-0.930). DISCUSSION: ARB initiation was associated with modestly lower dementia risk, particularly vascular dementia, versus CCB initiation.
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Noma et al. (2026) conducted a cohort in Hypertension (n=52,019). Angiotensin receptor blockers (ARBs) vs. Calcium channel blockers (CCBs) was evaluated on Incident all-cause dementia (HR 0.916, 95% CI 0.852-0.985). Initiation of angiotensin receptor blockers was associated with a lower risk of all-cause dementia compared with calcium channel blockers (HR 0.916) in older adults.
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