Risk of MCI Progression to Dementia Reduced with ARBs vs Other Hypertension Rx

In adults with mild cognitive impairment (MCI), taking an angiotensin receptor blocker (ARB) for treatment of hypertension may reduce progression to dementia, according to investigators in China.

Their research, published in Hypertension, compared the risk of advancement from MCI to dementia with ARBs with that seen with use of angiotensin converting enzyme (ACE) inhibitors, ß-blockers, calcium channel blockers (CCBs), diuretics, and with no hypertension treatment, following MCI patients receiving treatment for hypertension for a median of 3 years.

“The angiotensin hypothesis has recently been proposed that the renin-angiotensin system plays a role in brain function," wrote Zhenhong Deng, from the department of neurology at Sun Yat-sen Memorial Hospital, Sun Yat-sen University in Guangzhou, China, and colleagues. The hypothesis suggests, they explain, that medications, such as ARBs, that increase angiotensin-mediated activity at the angiotensin II and IV receptors may be more neuroprotective compared with agents that decrease that activity, eg, ACE inhibitors. What is still unclear is "whether and to what extent ARBs are superior to ACE inhibitors in reducing progression to dementia in patients with mild cognitive impairment.”

“The angiotensin hypothesis has recently been proposed that the renin-angiotensin system plays a role in brain function." Medications such as ARBs, that increase antiotensin-mediated activity at the angiotensin II and IV receptors may be more neuroprotective compared with agents that decrease that activity, eg, ACE inhibitors.

For the retrospective cohort study the research team used patient data from the Alzheimer’s Disease Neuroimaging Initiative, developed by the Laboratory of Neuroimaging at the University of Southern California. Deng et al identified 403 patients who had hypertension and MCI at baseline. The cohort had a mean age of 74 years and 38% were women.

During the 3-year follow-up period, investigators note, information on antihypertensive medications received was self-reported.

The primary outcome was progression to dementia and investigators used Cox proportional hazards models adjusted for potential confounding variables in their time-to-event analysis.

Findings

Over the 3-year follow-up, 39.2% of the participants progressed from baseline MCI to dementia. Comparisons between ARBs and other antihypertensive agents on the risk of progression found:

• ARBs, when compared with ACE inhibitors, were associated with lower risk of progression to dementia: adjusted hazard ratio (aHR) = 0.45, 95% CI 0.25–0.81, P=.023.
• ARB therapy for hypertension compared with use of ß-blockers, CCBs, and diuretics also was associated with lower risk for progression of MCI to dementia: aHR = 0.49, 95% CI, 0.27-0.89, P=.037.
• Compared with no treatment for hypertension, treatment with ARBs were again associated with lower risk for progression to dementia: aHR = 0.31, 95% CI, 0.16-0.58, P=.001.

The authors caution that while their findings may have “important implications for clinical practice” they should be investigated further in "larger, prospective cohorts or clinical trials.”

Reference: Deng Z, Jiang J, Wang J, et al. Angiotensin receptor blockers are associated with lower risk of progression from mild cognitive impairment to dementia. Hypertension. 2022;0:10.1161/HYPERTENSIONAHA.122.19378. Published online June 29, 2022