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Angiotensin-Receptor Blockers Associated With Reduced Incidence of Dementia and Progression to Dementia: Presented at ICAD

By Ed Susman

CHICAGO -- July 28, 2008 -- Patients who are taking angiotensin-receptor blockers (ARBs) for treatment of high blood pressure appear to have a reduced progression to Alzheimer's disease and other dementias, even when compared with patients taking angiotensin-converting enzyme (ACE) inhibitors, researchers said here at the 2008 International Conference on Alzheimer's Disease (ICAD).

"Angiotensin-receptor blockers appear to be neuroprotective," said Benjamin Wolozin, MD, Boston University School of Medicine, Boston, Massachusetts.

Dr. Wolozin and colleagues reviewed data from the United States' Veterans Affairs database from 2002 to 2006, identifying patients aged >65 years who were treated with ARBs, the ACE inhibitor lisinopril, and other cardiovascular medications. The 3 groups of patients were then compared with one another regarding development of dementia and then progression of dementia as defined by prescriptions for new neuroleptic drugs, transfer of the patient to a nursing home, or death.

"We found that use of angiotensin-receptor blockers is associated with a significant reduction in the incidence and progression of Alzheimer's disease, or dementia generally, compared with either users of ACE inhibitors or other cardiovascular medications," Dr. Wolozin said in an oral presentation on July 27.

The study included 185,906 patients who were taking 1 of 5 different angiotensin-receptor blockers (candesartan, irbesartan, telmisartan, losartan, and valsartan), 804,702 patients who were prescribed lisinopril, and 1,715,438 patients who were taking other cardiovascular medications. The subjects were about 74 years old, and about 98% were men.

After 4 years of follow-up, 1% of the patients on ARBs were diagnosed with Alzheimer's disease and 4% were diagnosed with dementia; 1.5% of those taking the ACE inhibitor or other cardiovascular medications were diagnosed with Alzheimer's disease, and 5% were diagnosed with dementia. Although the percentages are small, Dr. Wolozin said the large number of subjects in the study provided the statistical power to make those differences statistically significant (P < .0001).

He said that taking ARBs decreased the risk of developing dementia by 20% compared with lisinopril and by 33% compared with the other cardiovascular medications.

Similarly, the progression of disease was higher among those subjects taking the ACE inhibitors or other cardiovascular medications. Patients on ARBs had a lower risk of requiring new neuroleptic drugs by 23% (P < .05) compared with general cardiovascular treatment and by 14% compared with lisinopril (P = NS). They reduced their odds of having to be placed in a nursing home by 53% compared with cardiovascular drugs
(P < .0001) and by 38% compared with lisinopril (P < .05). Their odds of death were reduced by 36% when compared with those on other cardiovascular drugs (P < .0001) and by 23% (P < .05) compared with patients taking lisinopril.

"It would not be responsible to make any recommendations for treatment based on this study," Dr. Wolozin said. "We need to replicate the results of this retrospective study with other large databases of patients, and such a study is being performed by researchers at Kaiser Permanente of Northern California."

He said that if the Kaiser study replicates his results, then a prospective study would be warranted.

[Presentation title: Use of Angiotensin Receptor Blockers Is Associated With a Lower Incidence and Progression of Alzheimer Disease. Abstract O1-05-05]

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