Ebihara Takae, Ohrui Takashi, Ebihara Satoru, Tsuji Ichirou, Sasaki Hidetada, Arai Hiroyuki
Department of Geriatrics and Gerontology, Tohoku University School of Medicine, Japan.
Nihon Ronen Igakkai Zasshi. 2007 Jul;44(4):448-51. doi: 10.3143/geriatrics.44.448.
Angiotensin converting enzyme (ACE) inhibitor plays an important role not only as an antihypertensive drug but also for prevention of various complications related to geriatric syndrome. Pneumonia in the disabled elderly is mostly due to silent aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract. Aspiration is related to the dysfunction of dopaminergic neurons by cerebrovascular disease, resulting in impairments in both the swallowing and cough reflexes. ACE inhibitor can increase in the sensitivity of the cough reflex particularly in older post-menopausal women, and improvement of the swallowing reflex. In a 2-year follow-up study in stroke patients, patients who did not receive ACE inhibitors had a higher risk of mortality due to pneumonia than in stroke patients who were treated with ACE inhibitor. Moreover, the mortality of pneumonia was significantly lower in older hypertensive patients given ACE inhibitors than in those treated with other antihypertensive drugs. On the other hand, we found a new benefit of ACE inhibitor on the central nervous system. The mortality in Alzheimer's disease patients who received brain-penetrating ACE inhibitor was lower than in those who received other antihypertensive drugs. In a 1-year follow-up study, cognitive decline was lower in patients receiving brain-penetrating ACE inhibitors than in patients receiving a non-brain-penetrating ACE inhibitor or a calcium channel blocker. Brain-penetrating ACE inhibitors may slow cognitive decline in patients with mild to moderate Alzheimer's disease. ACE inhibitor might be effective for the disabled elderly, resulting in the prevention of aspiration pneumonia and Alzheimer's disease for the elderly.
血管紧张素转换酶（ACE）抑制剂不仅作为一种降压药物发挥重要作用，而且对于预防与老年综合征相关的各种并发症也很重要。残疾老年人的肺炎大多是由于口咽细菌病原体无声吸入下呼吸道所致。吸入与脑血管疾病导致的多巴胺能神经元功能障碍有关，从而导致吞咽和咳嗽反射受损。ACE抑制剂可提高咳嗽反射的敏感性，尤其是在绝经后老年女性中，并改善吞咽反射。在一项针对中风患者的2年随访研究中，未接受ACE抑制剂治疗的患者因肺炎导致的死亡风险高于接受ACE抑制剂治疗的中风患者。此外，服用ACE抑制剂的老年高血压患者的肺炎死亡率明显低于服用其他降压药物的患者。另一方面，我们发现了ACE抑制剂对中枢神经系统的新益处。接受能穿透血脑屏障的ACE抑制剂治疗的阿尔茨海默病患者的死亡率低于接受其他降压药物治疗的患者。在一项1年的随访研究中，接受能穿透血脑屏障的ACE抑制剂治疗的患者的认知能力下降程度低于接受不能穿透血脑屏障的ACE抑制剂或钙通道阻滞剂治疗的患者。能穿透血脑屏障的ACE抑制剂可能会减缓轻度至中度阿尔茨海默病患者的认知能力下降。ACE抑制剂可能对残疾老年人有效，从而预防老年人的吸入性肺炎和阿尔茨海默病。
