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ARBs blood pressure med may cut risk of Alzheimer's disease
  October 28, 2011 Megan Brooks

Bristol, UK - Controlling blood pressure with an angiotensin II-receptor blocker (ARB) rather than other antihypertensive agents may significantly reduce the risk of Alzheimer's disease (AD) and vascular dementia, suggest results of a large observational study from the UK [1].

In the study, the risk of AD was 53% lower in older adults prescribed an ARB compared with those prescribed other antihypertensive agents. The risk was 24% lower in those prescribed an ACE inhibitor.

Dr Patrick G Kehoe (Frenchay Hospital, Bristol, UK) and colleagues report their study in the October 2011 issue of the Journal of Alzheimer's Disease.

The accumulating observational and biological evidence in favor of ARBs protecting against dementia "strengthens the need for them to be studied more rigorously in the future," Kehoe and colleagues conclude.

The new study was a nested-case-control study within the UK general-practice research database. It was designed to see whether ARBs and ACE inhibitors are more strongly associated with AD, vascular dementia (VaD), and other dementias relative to other antihypertensive drugs such as calcium-channel blockers, beta blockers, or thiazide diuretics.

Included in the analysis were 9197 cases-adults aged 60 and older who were diagnosed between 1997 and 2008 with probable or possible AD (n=5797), VaD (n=2186), or unspecified/other dementia (n=1214). Each case was matched by age, general practice, and gender to as many as four controls (n=39 166).

The researchers observed that patients ever prescribed either ARBs or ACE inhibitors were less likely to develop AD, VaD, or other dementias than patients ever prescribed other antihypertensive medications. The associations were stronger for ARBs than for ACE inhibitors.

Dementia risk (odds ratio, 95% CI) with ARBs and ACE inhibitors compared with other agents


These associations did not differ by age, comorbidities, or blood pressure, suggesting little confounding by observed comorbidities, the researchers say. There was also evidence of a dose-response relationship between ARBs and AD (p=0.009).

In analyses restricted to patients exposed either to ARBs or ACE inhibitors as their only therapy, there was an inverse association of ARB sole therapy (OR 0.63; 95% CI 0.45-0.88), but not ACE-inhibitor sole therapy (OR 1.01; 95% CI 0.91-1.12).

Reached for comment, Dr Gustavo C Roman (Nantz National Alzheimer Center, Houston, TX), who was not involved in the study, said that it "reaffirms the need to control blood pressure, and the sooner, the better."

Roman said he has been "preaching to the people that you need to keep your blood pressure under good control because it really seems that vascular disease-and especially hypertension-open the gate to the amyloid-beta changes, although the mechanism is not very clear.

"Whatever the mechanism, it has been demonstrated over and over that vascular disease, in particular hypertension, is a risk factor for the development of Alzheimer's disease," he added.


Davies NM, Kehoe PG, Ben-Shlomo T, Martin RM. Associations of anti-hypertensive treatments with Alzheimer's disease, vascular dementia, and other dementias. J Alzheimer's Dis 2011; 26:699-708

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