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Observational study of brain atrophy and cognitive decline comparing a sample of community-dwelling people taking angiotensin converting enzyme inhibitors and angiotensin receptor blockers over time

Citation

Moran, C and Xie, K and Poh, S and Chew, S and Beare, R and Wang, W and Callisaya, M and Srikanth, V, Observational study of brain atrophy and cognitive decline comparing a sample of community-dwelling people taking angiotensin converting enzyme inhibitors and angiotensin receptor blockers over time, Journal of Alzheimer's Disease, 68, (4) pp. 1479-1488. ISSN 1387-2877 (2019) [Refereed Article]


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Copyright Statement

Copyright 2019 IOS Press and the authors. The final publication is available at IOS Press through http://dx.doi.org/10.3233/JAD-180943

DOI: doi:10.3233/JAD-180943

Abstract

Background: Hypertension is an established risk factor for dementia. However, it is unclear whether there are differential effects of angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blockers (ARB) on brain health. In human observational studies, the evidence for superiority of either agent remains unclear.

Objective: To compare brain atrophy and cognitive decline between people treated with ACEi or ARB.

Methods: Participants aged 55-90 years without dementia had brain magnetic resonance imaging and neuropsychological assessments performed at 3 time points. The sample was enriched with people with type 2 diabetes (T2D). Multivariable mixed models were used to examine longitudinal associations of antihypertensive medication class with change in cognition and total brain volume.

Results: Of 565 people with longitudinal data, there were 163 on ACEi (mean age 69.9 years, T2D:64% with) and 125 on ARB (mean age 69.6 years, T2D:62%) at baseline. The baseline characteristics of those taking either an ACEi or ARB were similar with regards to age, sex, blood pressure control, and vascular risk factors. The mean duration of follow up was 3.2 years. The baseline association of ACEi and ARB use with total brain volume was similar in both groups. However, those taking an ARB had a slower rate of brain atrophy than those taking an ACEi (p = 0.031). Neither ACEi nor ARB use was associated with baseline cognitive function or cognitive decline.

Conclusions: These results support the theory that ARB may be preferable to ACEi to reduce brain atrophy. The mechanisms underlying this differential association warrant further investigation.

Item Details

Item Type:Refereed Article
Keywords:angiotensin-converting enzyme inhibitors, antihypertensive agents, blood pressure, cognition, dementia
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Geriatrics and Gerontology
Objective Division:Health
Objective Group:Specific Population Health (excl. Indigenous Health)
Objective Field:Health Related to Ageing
UTAS Author:Callisaya, M (Dr Michele Callisaya)
UTAS Author:Srikanth, V (Dr Velandai Srikanth)
ID Code:133262
Year Published:2019
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-06-20
Last Modified:2019-07-23
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