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Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: results from the Cardiovascular Health Study.
Tuesday,2012-11-06 12:18 America/Los_Angeles — eenright
| Title | Angiotensin-converting enzyme inhibitors and cognitive decline in older adults with hypertension: results from the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2009 |
| Authors | Sink, KM, Leng, X, Williamson, J, Kritchevsky, SB, Yaffe, K, Kuller, L, Yasar, S, Atkinson, H, Robbins, M, Psaty, B, Goff, DC |
| Journal | Arch Intern Med |
| Volume | 169 |
| Issue | 13 |
| Pagination | 1195-202 |
| Date Published | 2009 Jul 13 |
| ISSN | 1538-3679 |
| Keywords | Aged, Angiotensin-Converting Enzyme Inhibitors, Blood-Brain Barrier, Cognition, Dementia, Female, Follow-Up Studies, Humans, Hypertension, Incidence, Male, Prospective Studies, Risk Factors |
| Abstract | <p><b>BACKGROUND: </b>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.</p><p><b>METHODS: </b>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).</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p> |
| DOI | 10.1001/archinternmed.2009.175 |
| Alternate Journal | Arch. Intern. Med. |
| PubMed ID | 19597068 |
| PubMed Central ID | PMC2881686 |
| Grant List | AG15928 / AG / NIA NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States R01 AG015928 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States U01 HL080295-01 / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States R01 HL074745 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States 5R01HL074745-04 / HL / NHLBI NIH HHS / United States P30 AG21332 / AG / NIA NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States N01-HC-55222 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States P30 AG021332 / AG / NIA NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States |