Department of Neurology (Z.D., J.J., J.W., D.P., Y.Z., H.L., X.Z.,X.L., Y.X., Y.L., Y.T.), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Division of Clinical Research Design (Y.Z., Y.T.), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Hypertension. 2022 Oct;79(10):2159-2169. doi: 10.1161/HYPERTENSIONAHA.122.19378. Epub 2022 Jun 29.
Previous studies found that antihypertensive medications (AHMs) acting on the renin-angiotensin system had the potential to reduce the progression from mild cognitive impairment to dementia. However, it remains unclear whether this association differs between ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers.
We conducted a retrospective cohort study in the Alzheimer's Disease Neuroimaging Initiative among 403 participants with hypertension and mild cognitive impairment at baseline. Information on AHMs received during the follow-up period, including angiotensin receptor blockers, ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics, were self-reported. Cox proportional hazards models adjusted for potential confounders were used in the time to event analysis with progression to dementia as outcome.
Of the 403 participants, the mean (SD) age was 74.0 (7.3) years, 152 (37.7%) were female, 158 (39.2%) progressed to dementia over a median follow-up time of 3.0 years. Angiotensin receptor blockers were associated with a lower risk of progression to dementia as compared to ACE inhibitors (adjusted hazard ratio=0.45 [95% CI, 0.25-0.81]; =0.023), other classes of AHMs (beta-blockers, calcium channel blockers, diuretics; adjusted hazard ratio, 0.49 [95% CI, 0.27-0.89]; =0.037), and none of AHMs (adjusted hazard ratio, 0.31 [95% CI, 0.16-0.58]; =0.001).
In patients with hypertension and mild cognitive impairment, angiotensin receptor blockers were associated with a lower risk of progression to dementia compared with ACE inhibitors and other classes of AHMs. Our findings may have important implications for clinical practice but still warrant further investigations in larger prospective cohorts or clinical trials.
先前的研究发现，作用于肾素-血管紧张素系统的降压药物（AHMs）有可能降低轻度认知障碍向痴呆的进展。然而，目前尚不清楚这种关联在血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂之间是否存在差异。
我们在阿尔茨海默病神经影像学倡议中进行了一项回顾性队列研究，纳入了 403 名基线时患有高血压和轻度认知障碍的参与者。在随访期间接受的 AHMs 信息，包括血管紧张素受体阻滞剂、ACE 抑制剂、β受体阻滞剂、钙通道阻滞剂和利尿剂，均为自我报告。在时间到事件分析中，使用 Cox 比例风险模型调整了潜在的混杂因素，以痴呆进展为结局。
在 403 名参与者中，平均（SD）年龄为 74.0（7.3）岁，152 名（37.7%）为女性，中位随访时间为 3.0 年，158 名（39.2%）进展为痴呆。与 ACE 抑制剂相比，血管紧张素受体阻滞剂与痴呆进展的风险较低相关（调整后的危险比=0.45 [95%置信区间，0.25-0.81]；=0.023），其他类别的 AHMs（β受体阻滞剂、钙通道阻滞剂、利尿剂；调整后的危险比=0.49 [95%置信区间，0.27-0.89]；=0.037），以及没有 AHMs（调整后的危险比=0.31 [95%置信区间，0.16-0.58]；=0.001）。
在患有高血压和轻度认知障碍的患者中，与 ACE 抑制剂和其他类别的 AHMs 相比，血管紧张素受体阻滞剂与痴呆进展的风险较低相关。我们的研究结果可能对临床实践具有重要意义，但仍需要在更大的前瞻性队列或临床试验中进一步研究。
