A secondary analysis of a randomized blood pressure (BP) intervention trial suggested that certain BP medications could be used to prevent the development of cognitive decline. The analysis (April 2011 to July 2018) included 8685 patients of high BP 50 years or older with increased cardiovascular risk but without a history of diabetes, stroke, or dementia, who were prevalent users of BP medication regimens at the 6-month study visit (mean age, 67.7 years; 64.3% male; 10.8% Hispanic, 30.0% non-Hispanic Black, 57.4% non-Hispanic White, and 1.9% who responded as other race or ethnicity), 30.4% were users of exclusively stimulating (ie, angiotensin II receptor type 1 blockers, dihydropyridine calcium channel blockers, and thiazide diuretics), 17.7% inhibiting (ie, ACE inhibitors, β-blockers, and nondihydropyridine calcium channel blockers), and 51.9% mixed antihypertensive medication regimens. During a median of 4.8 years of follow-up, there were 45 vs 59 cases per 1000 person-years of amnestic mild cognitive impairment (MCI) or probable dementia among prevalent users of regimens that contained exclusively stimulating vs inhibiting antihypertensive medications (hazard ratio [HR], 0.76). When comparing stimulating-only vs inhibiting-only users, amnestic MCI occurred at rates of 40 vs 54 cases per 1000 person-years (HR, 0.74) and probable dementia at rates of 8 vs 10 cases per 1000 person-years (HR, 0.80). However, negative control outcome analyses suggested the presence of residual confounding. The findings extend previous studies and suggest that BP medications that stimulate vs inhibit type 2 and 4 angiotensin II receptors could be prioritized to prevent cognitive decline. High BP is a leading modifiable risk factor for dementia. Source: https://jamanetwork.com/
