The Johns Hopkins University, Baltimore, MD, USA.
Neurology. 2013 Sep 3;81(10):896-903. doi: 10.1212/WNL.0b013e3182a35228. Epub 2013 Aug 2.
The aim of this study was to determine whether use of diuretics, angiotensin-1 receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACE-I), calcium channel blockers (CCB), or β-blockers (BB) was associated with a reduced risk of Alzheimer disease (AD) dementia in participants with normal cognition or mild cognitive impairment (MCI).
Secondary longitudinal data analysis of the Ginkgo Evaluation of Memory Study in older adults at least 75 years of age with normal cognition (n = 1,928) or MCI (n = 320) over a median 6.1-year period using Cox proportional hazard models after adjusting for confounders.
Diuretic use was reported by 15.6%, ARB 6.1%, ACE-I 15.1%, CCB 14.8%, and BB 20.5%. Of the 2,248 participants, 290 (13%) developed AD dementia. Hazard ratio for incident AD dementia among participants with normal cognition was 0.51 in diuretic (95% confidence interval [CI] 0.31-0.82), 0.31 in ARB (95% CI 0.14-0.68), 0.50 in ACE-I (95% CI 0.29-0.83), 0.62 in CCB (95% CI 0.35-1.09), and 0.58 in BB (95% CI 0.36-0.93) users and was not significantly altered when mean systolic blood pressure was above 140 mm Hg. In participants with MCI, only diuretic use was associated with decreased risk (hazard ratio = 0.38, 95% CI 0.20-0.73).
Diuretic, ARB, and ACE-I use was, in addition to and/or independently of mean systolic blood pressure, associated with reduced risk of AD dementia in participants with normal cognition, while only diuretic use was associated with reduced risk in participants with MCI.
本研究旨在确定在认知正常或轻度认知障碍（MCI）的参与者中，使用利尿剂、血管紧张素-1 受体阻滞剂（ARB）、血管紧张素转换酶抑制剂（ACE-I）、钙通道阻滞剂（CCB）或β受体阻滞剂（BB）是否与阿尔茨海默病（AD）痴呆风险降低相关。
对年龄在 75 岁及以上、认知正常（n=1928）或 MCI（n=320）的银杏叶评估记忆研究中的老年人进行二次纵向数据分析，在调整混杂因素后，使用 Cox 比例风险模型进行中位 6.1 年的随访。
报告使用利尿剂的参与者占 15.6%，ARB 占 6.1%，ACE-I 占 15.1%，CCB 占 14.8%，BB 占 20.5%。在 2248 名参与者中，有 290 名（13%）发生 AD 痴呆。认知正常参与者中 AD 痴呆的发生率，利尿剂组为 0.51（95%置信区间[CI] 0.31-0.82），ARB 组为 0.31（95% CI 0.14-0.68），ACE-I 组为 0.50（95% CI 0.29-0.83），CCB 组为 0.62（95% CI 0.35-1.09），BB 组为 0.58（95% CI 0.36-0.93），当平均收缩压高于 140mmHg 时，风险比没有显著改变。在 MCI 参与者中，仅利尿剂的使用与降低风险相关（风险比=0.38，95% CI 0.20-0.73）。
除了平均收缩压以外，利尿剂、ARB 和 ACE-I 的使用与认知正常参与者 AD 痴呆风险降低相关，而在 MCI 参与者中，仅利尿剂的使用与降低风险相关。
