Key result
RAAS modulation with ARBs may offer cognitive benefits in hypertension or diabetes despite heterogeneous evidence.
Why the study?
The systematic review was conducted to explore the influence of the renin-angiotensin-aldosterone system (RAAS) on cognitive and neuropsychiatric outcomes by synthesizing clinical and preclinical evidence on RAAS-modulating therapies.
Do RAAS-modulating therapies improve cognitive function or delay dementia progression in adults at risk of or diagnosed with cognitive impairment?
Systematic Review
Do RAAS-modulating therapies improve cognitive function or delay dementia progression in adults at risk of or diagnosed with cognitive impairment?
RAAS modulation, particularly with ARBs, shows potential for preserving cognitive function in patients with vascular risk factors, though evidence remains heterogeneous and requires confirmation in dedicated trials.
ARBs may warrant consideration for cognitive preservation in hypertension or diabetes; leaves open definitive efficacy pending dedicated RCTs.
This systematic review explores the influence of the renin-angiotensin-aldosterone system (RAAS) on cognitive and neuropsychiatric outcomes, synthesizing evidence from clinical and preclinical studies investigating RAAS-modulating therapies such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). A comprehensive literature search across four major databases yielded seven studies that met the inclusion criteria, including randomized controlled trials, observational studies, and one animal model experiment. The findings suggest that RAAS modulation, particularly through ARBs, may offer cognitive benefits in certain populations, especially those with hypertension, type 2 diabetes, or vascular risk factors. Some studies demonstrated improvements in executive function, memory, and global cognition, while others found no statistically significant effect on neurodegeneration or cognitive decline. Mechanistic insights indicate that RAAS-targeting interventions may reduce neuroinflammation, oxidative stress, and microvascular dysfunction, which are pathways implicated in cognitive impairment. Although promising, the evidence is varied in methodological quality and consistency, highlighting the need for future trials with cognitive endpoints as primary outcomes.
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Subhani et al. (2025) conducted a systematic review in Cognitive impairment and dementia. RAAS-modulating therapies (ACE inhibitors and ARBs) vs. Placebo, non-RAAS antihypertensive agents, or no treatment was evaluated on Cognitive function, dementia progression, and neuropsychiatric symptoms. RAAS modulation, particularly with angiotensin receptor blockers, may offer cognitive benefits in populations with hypertension or diabetes, though clinical evidence remains heterogeneous.
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