Alz Res Therapy: How does angiotensin antihypertensive drug affect cognitive function?

Hypertension currently affects approximately two-thirds of Americans aged 65 or older, and its burden has been steadily increasing over the past few decades
.

In addition to being a major factor in cardiovascular disease risk and mortality, hypertension has recently been identified as an important independent risk factor for cognitive decline and Alzheimer's disease (AD) dementia

Therefore, the relationship between the use of antihypertensive drugs and the incidence of dementia and cognitive decline has become an important research area
.

Some evidence suggests that the decrease in cerebral blood flow associated with hypertension can be reversed by antihypertensive therapy, which may reduce the cognitive and functional decline associated with AD

Some observational studies have linked the use of any antihypertensive drug with a reduced risk of developing dementia or cognitive decline, but other studies have found no obvious benefit to one or two results

The direct head-to-head comparison of ARB and ACE-Is is limited, but studies have shown that, compared with the use of ACE-I, ARB use is associated with less brain atrophy, lower incidence of dementia, and slower cognitive decline Related
.

In previous pathological studies, there are fewer plaques and tangles in the use of ARB compared with ACE-I, which indicates that these drugs may have different effects on the pathological development of AD, so it can be studied specifically in the context of AD Its impact

In this way, Michael Ouk of the University of Toronto and others compared the memory and other cognitive outcomes of users of ACE-Is and ARBs who were diagnosed with AD dementia
.

Using the relatively large sample size in the National Alzheimer's Coordination Center (NACC) database, the study further aims to clarify the factors that may contribute to the heterogeneity in the existing literature

In addition, previous evidence supports the association between APOE genotypes and neurological outcomes in ARB or ACE-Is users
.

In addition, in light of conflicting evidence that the ability of these drugs to penetrate the blood-brain barrier (BBB) ​​may be part of their neurological benefits, they further compared ARBs and ACE-Is that cross the BBB and that that do not cross the BBB

In addition, in light of conflicting evidence that the ability of these drugs to penetrate the blood-brain barrier (BBB) ​​may be part of their neurological benefits, they further compared ARBs and ACE-Is that cross the BBB and that that do not cross the BBB

In 1689 AD patients, the use of ARB (n = 578) was compared with the use of ACE-I (n = 1111).

During an average follow-up of 2.

There was an interaction with APOE ε4 status (drug × APOE × time RR=1.
196, p=0.
033); among non-carriers, ARBs had better delayed recall performance than ACE-Is (RR=1.
200, p =0.
003), but not among carriers (RR=1.
003, p=0.
957)
.

The use of ARB is also related to the long-term performance of TMT-A and DSST (B=0.
573 symbols, p=0.
0485), and these differences are obvious in APOE ε4 non-carriers
.

Among non-carriers of APOE ε4, there are also some differences in language and verbal fluency
.

The significance of this study lies in the discovery: in APOE ε4 non-carriers with AD, the use of ARB is related to greater preservation of memory and attention/psychomotor processing speed, especially ACE that does not cross the blood-brain barrier -Is compared
.

In APOE ε4 non-carriers with AD, the use of ARB is associated with greater preservation of memory and attention/psychomotor processing speed, especially when compared to ACE-Is that do not cross the blood-brain barrier
.

Original source:
Ouk M, Wu CY, Rabin JS, et al.
The use of angiotensin-converting enzyme inhibitors vs.
angiotensin receptor blockers and cognitive decline in Alzheimer's disease: the importance of blood-brain barrier penetration and APOE ε4 carrier status.
Alz Res Therapy.
2021;13(1):43.
doi:10.
1186/s13195-021-00778-8

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