Antihypertensives Stimulate Type 2 and 4 Angiotensin II Receptors Linked to Lower Dementia Risk

A US cohort study suggested that initiation of medications for high blood pressure that stimulate vs inhibit type 2 and 4 angiotensin II receptors may result in a lower risk of incident dementia. The study included 57 773 patients aged 65 years or older with incident high blood pressure from January 1, 2006, through December 31, 2018; women 62.9%; mean age, 73.8 years; 5.1% Black, 2.7% Hispanic; 86.9% White, and 5.4% Other individuals (American Indian, Asian, other, or unknown race and ethnicity). During a median of 6.9 years of follow-up, the unadjusted incidence density rate of Alzheimer disease and related dementias (ADRD) was 2.2 cases per 100 person-years for the group receiving regimens that stimulate type 2 and 4 angiotensin II receptors (angiotensin II receptor type 1 blockers, dihydropyridine calcium channel blockers, thiazide diuretics) compared with 3.1 cases per 100 person-years for the group receiving regimens that inhibit type 2 and 4 angiotensin II receptors (angiotensin-converting enzyme inhibitors, β-blockers, nondihydropyridine calcium channel blockers) and 2.7 cases per 100 person-years for the group receiving mixed treatment regimens. In adjusted Cox proportional hazards regression modeling, stimulating treatment was associated with a statistically significant 16% reduction in the hazard of ADRD compared with inhibiting treatment (hazard ratio, 0.84). Mixed regimen use was also associated with reduced hazards of ADRD compared with the inhibiting group (hazard ratio, 0.90). The findings need to be confirmed in a randomized trial. Source: https://jamanetwork.com/