BACKGROUND AND PURPOSE:

• Hypertension is a known risk factor for dementia and Alzheimer’s disease (AD)
• Cheung et al. (Age and Ageing, 2025) investigated whether exposure to different antihypertensive drug classes impacts dementia risk

METHODS:

• Multinational population-based cohort study
  • Databases from Hong Kong, the UK, Sweden and Australia
• Population
  • Adults ≥40 years
  • New users of antihypertensive drugs
• Exposure
  • Antihypertensive drug class
• Study design
  • Exposure groups      
    • ACE inhibitors (ACEI) | Angiotensin-II receptor blockers (ARB) | Beta-blockers | Calcium channel blockers (CCB) | Diuretics | Combination of above that did not include ACEI  
  • Adjusted Cox proportional hazards models used to generate results in each study site
    • These were then pooled in meta-analysis
• Primary outcome
  • All-cause dementia
• Secondary outcomes
  • Alzheimer’s disease
  • Vascular dementia

RESULTS:

• 1,925,563 participants
  • Median follow-up range across study sites: 5.6 to 8.4 years
  • Most common class of medication varied between countries
• Compared to ACEIs, ARBs were associated with a reduced risk of incident
  • All-cause dementia
    • Hazard ratio (HR) 0.92 (95% CI, 0.89 to 0.94)
  • Vascular dementia
    • HR 0.87 (95% CI, 0.78 to 0.96)
  • No differences were seen with other drug classes
• There was no reduction in risk of Alzheimer’s disease with ARBs vs ACEIs
  • HR 0.92 (95% CI, 0.84 to 1.00)

CONCLUSION:

• ARBs were associated with a reduced risk of all-cause dementia and vascular dementia compared to ACEIs
• The authors state

Although an HR of 0.92 may suggest a modest risk reduction, even small changes in dementia incidence can have a large impact on relieving the growing burden of dementia

The results of this study can inform evidence-based guidelines for antihypertensive treatment in generalisable clinical settings and will be of relevance in the decision-making process of both clinicians and patients 

Learn More – Primary Sources:

Antihypertensive drug classes and risk of incident dementia: a multinational population-based cohort study