USA: A recent study in JAMA Network Open suggests that the use of certain antihypertensive medications could prevent the development of cognitive decline.
"Findings from secondary analysis of SPRINT showed that prevalent users of regimens that contain exclusively antihypertensive medications (that stimulate vs inhibit type 2 and 4 angiotensin II receptors) had reduced rates of incident cognitive impairment," Zachary A. Marcum, University of Washington, Seattle, and colleagues wrote in their study. "Our results, if replicated in randomized clinical trials, certain antihypertensive medications could be prioritized for preventing cognitive decline."
This secondary analysis of the SPRINT cohort study demonstrated that type 2 and 4 angiotensin II receptor (AT2R/AT4R)-stimulating antihypertensives decreased the risk of amnestic mild cognitive impairment or probable dementia by approximately 25% compared to AT2R/AT4R-inhibiting antihypertensives.
Previous studies have shown that the use of antihypertensive medications that stimulate type 2 and 4 angiotensin II receptors versus those that do not stimulate these receptors, has been related to lower dementia risk. However, there has been no evaluation on this association with cognitive outcomes in hypertension trials, with blood pressure levels in the range of current guidelines.
Considering the above, Dr. Marcum and the team aimed to examine the association between the use of exclusively antihypertensive medication regimens that stimulate vs inhibit type 2 and 4 angiotensin II receptors on mild cognitive impairment (MCI) or dementia in a cohort study.
The researchers conducted a secondary analysis of participants in the randomized Systolic Blood Pressure Intervention Trial (SPRINT). The trial recruited individuals 50 years or older with hypertension and increased cardiovascular risk without a history of diabetes, stroke, or dementia. Data were analyzed from March 16 to July 6, 2021.
The primary outcome was a composite of adjudicated amnestic MCI or probable dementia.
Of the 8685 SPRINT participants who were prevalent users of antihypertensive medication regimens at the 6-month study visit (mean age, 67.7 years; 5586 [64.3%] male), 2644 (30.4%) were users of exclusively stimulating, 1536 (17.7%) inhibiting, and 4505 (51.9%) mixed antihypertensive medication regimens.
Following were the study's key findings:
During a median of 4.8 years of follow-up, there were 45 vs 59 cases per 1000 person-years of amnestic 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).
Negative control outcome analyses suggested the presence of residual confounding.
"In SPRINT, prevalent users of regimens that contain exclusively antihypertensives that stimulate vs inhibit type 2 and 4 angiotensin II receptors had lower rates of cognitive impairment," the authors concluded.
Reference:
Marcum ZA, Cohen JB, Zhang C, et al. Association of Antihypertensives That Stimulate vs Inhibit Types 2 and 4 Angiotensin II Receptors With Cognitive Impairment. JAMA Netw Open. 2022;5(1):e2145319. doi:10.1001/jamanetworkopen.2021.45319