03350nas a2200421 4500008004100000022001400041245014800055210006900203260001600272300001300288490000800301520213900309653000902448653004502457653002402502653001402526653001302540653001102553653002202564653001102586653001702597653001402614653000902628653002402637653001702661100002002678700001802698700002102716700002802737700002002765700001802785700001702803700001802820700001802838700001702856700001902873856003602892 2009 eng d a1538-367900aAngiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: results from the Cardiovascular Health Study.0 aAngiotensinconverting enzyme inhibitors and cognitive decline in c2009 Jul 13 a1195-2020 v1693 a

BACKGROUND: Hypertension (HTN) is a risk factor for dementia, and animal studies suggest that centrally active angiotensin-converting enzyme (ACE) inhibitors (those that cross the blood-brain barrier) may protect against dementia beyond HTN control.

METHODS: Participants in the Cardiovascular Health Study Cognition Substudy with treated HTN and no diagnosis of congestive heart failure (n = 1054; mean age, 75 years) were followed up for a median of 6 years to determine whether cumulative exposure to ACE inhibitors (as a class and by central activity), compared with other anti-HTN agents, was associated with a lower risk of incident dementia, cognitive decline (by Modified Mini-Mental State Examination [3MSE]), or incident disability in instrumental activities of daily living (IADLs).

RESULTS: Among 414 participants who were exposed to ACE inhibitors and 640 who were not, there were 158 cases of incident dementia. Compared with other anti-HTN drugs, there was no association between exposure to all ACE inhibitors and risk of dementia (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.88-1.15), difference in 3MSE scores (-0.32 points per year; P = .15), or odds of disability in IADLs (odds ratio [OR], 1.06; 95% CI, 0.99-1.14). Adjusted results were similar. However, centrally active ACE inhibitors were associated with 65% less decline in 3MSE scores per year of exposure (P = .01), and noncentrally active ACE inhibitors were associated with a greater risk of incident dementia (adjusted HR, 1.20; 95% CI, 1.00-1.43 per year of exposure) and greater odds of disability in IADLs (adjusted OR, 1.16; 95% CI, 1.03-1.30 per year of exposure) compared with other anti-HTN drugs.

CONCLUSIONS: While ACE inhibitors as a class do not appear to be independently associated with dementia risk or cognitive decline in older hypertensive adults, there may be within-class differences in regard to these outcomes. These results should be confirmed with a randomized clinical trial of a centrally active ACE inhibitor in the prevention of cognitive decline and dementia.

10aAged10aAngiotensin-Converting Enzyme Inhibitors10aBlood-Brain Barrier10aCognition10aDementia10aFemale10aFollow-Up Studies10aHumans10aHypertension10aIncidence10aMale10aProspective Studies10aRisk Factors1 aSink, Kaycee, M1 aLeng, Xiaoyan1 aWilliamson, Jeff1 aKritchevsky, Stephen, B1 aYaffe, Kristine1 aKuller, Lewis1 aYasar, Sevil1 aAtkinson, Hal1 aRobbins, Mike1 aPsaty, Bruce1 aGoff, David, C uhttps://chs-nhlbi.org/node/1112