Risk of Mild Cognitive Impairment or Probable Dementia in New Users of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors

Cohen, Jordana B.; Marcum, Zachary A.; Zhang, Chong; Derington, Catherine G.; Greene, Tom; Ghazi, Lama; Herrick, Jennifer S.; King, Jordan B.; Cheung, Alfred K.; Bryan, Nick; Supiano, Mark A.; Sonnen, Joshua A.; Weintraub, William S.; Scharfstein, Daniel O.; Williamson, Jeff D.; Pajewski, Nicholas M.; Bress, Adam P.

doi:10.1001/jamanetworkopen.2022.20680

Cited by 5 publications

(4 citation statements)

References 41 publications

(95 reference statements)

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“…Our findings on the contrasting risk of AD and ADRD between angiotensin-II stimulating vs. inhibiting antihypertensive drugs in a large cohort of men and women with colorectal cancer support the results and conclusions of previous studies by van Dalen et al (10), Marcum et al (11), and other researchers (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Although each study population was different, the magnitude and direction of the risk of AD and ADRD associated with angiotensin-II stimulating or inhibiting antihypertensive medications were consistent.…”

Section: Discussionsupporting

confidence: 91%

“…Marcum and colleagues (11) did a secondary analysis of participants aged ≥50 years with hypertension in the randomized Systolic Blood Pressure Intervention Trial (SPRINT) in 2011-2018 with a median of 4.8 years of follow-up, and also found that the risk of amnestic mild cognitive impairment (MCI) was significantly lower (hazard ratio: 0.74; 95% CI: 0.64-0.87) and probable dementia was insignificantly lower (0.80; 0.57-1.14) in those receiving stimulating-only vs. those inhibiting-only users. These associations between angiotensin-II stimulating antihypertensive users and a lower risk of ADRD were also reported in other studies (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Introductionsupporting

confidence: 85%

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Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer

Schulz

2023

Front. Cardiovasc. Med.

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BackgroundSeveral previous studies showed that patients who received angiotensin II–stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II–inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors.ObjectivesTo determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007–2015 with follow-up from 2007 to 2016.MethodsWe identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)—Medicare linked database in 17 SEER areas in 2007–2015 with follow-up to 2016, who were free of any diagnosed ADRD at the baseline (within 12 months prior to and 12 months after the date of diagnosis for colorectal cancer). All patients who were defined as having hypertension by ICD diagnosis code or received antihypertensive drugs during this baseline 2-year period were classified into 6 groups based on whether they received angiotensin-II stimulating or inhibiting antihypertensive drugs.ResultsCrude cumulative incidence rates of AD and ADRD were similar between those who received angiotensin II–stimulating antihypertensive medications (4.3% and 21.7%) and those receiving angiotensin II–inhibiting antihypertensive medications (4.2% and 23.5%). As compared to patients who received angiotensin II–stimulating antihypertensive drugs, those who received angiotensin II–inhibiting antihypertensives were significantly more likely to develop AD (adjusted hazard ratio: 1.15, 95% CI: 1.01–1.32), vascular dementias (1.27, 1.06–1.53), and total ADRD (1.21, 1.14–1.28) after adjusting for potential confounders. These results remained similar after adjusting for medication adherence and considering death as a competing risk.ConclusionsThe risk of AD and ADRD in patients with hypertension who received angiotensin II–inhibiting antihypertensive medications was higher than in those receiving angiotensin II–stimulating antihypertensive drugs in patients with colorectal cancer.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionsupporting

confidence: 85%

Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer

Schulz

2023

Front. Cardiovasc. Med.

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“… 38 These observations could represent important subpopulations that may particularly benefit from ARB versus ACEI initiation to prevent adverse CVD endpoints and merit further investigation. Similar to our prior report comparing the risk of cognitive outcomes among ARB versus ACEI new users, 39 the current analysis reports a lower adjusted risk of CVD among new users of an ARB versus ACEI in the standard treatment arm, but not the intensive SBP treatment arm. As with all subgroup analyses, these results should be interpreted with caution and indicate that the specific renin‐angiotensin system inhibitor (ARB or ACEI) may not meaningfully impact CVD events because of the substantial, independent benefit of intensive BP lowering.…”

Section: Discussionsupporting

confidence: 85%

New Users of Angiotensin II Receptor Blocker–Versus Angiotensin‐Converting Enzyme Inhibitor–Based Antihypertensive Medication Regimens and Cardiovascular Disease Events: A Secondary Analysis of ACCORD‐BP and SPRINT

King,

Berchie,

Derington

et al. 2023

JAHA

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BACKGROUND Angiotensin II receptor blockers (ARBs) and angiotensin‐converting enzyme inhibitors (ACEIs) block distinct components of the renin‐angiotensin system. Whether this translates into differential effects on cardiovascular disease events remains unclear. METHODS AND RESULTS We used the ACCORD‐BP (Action to Control Cardiovascular Risk in Diabetes–Blood Pressure) trial and the SPRINT (Systolic Blood Pressure Intervention Trial) to emulate target trials of new users of ARBs versus ACEIs on cardiovascular disease events (primary outcome) and death (secondary outcome). We estimated marginal cause‐specific hazard ratios (HRs) and treatment‐specific cumulative incidence functions with inverse probability of treatment weights. We identified 3298 new users of ARBs or ACEIs (ACCORD‐BP: 374 ARB versus 884 ACEI; SPRINT: 727 ARB versus 1313 ACEI). For participants initiating ARBs versus ACEIs, the inverse probability of treatment weight rate of the primary outcome was 3.2 versus 3.5 per 100 person‐years in ACCORD‐BP (HR, 0.91 [95% CI, 0.63–1.31]) and 1.8 versus 2.2 per 100 person‐years in SPRINT (HR, 0.81 [95% CI, 0.56–1.18]). There were no appreciable differences in pooled analyses, except that ARBs versus ACEIs were associated with a lower death rate (HR, 0.56 [95% CI, 0.37–0.85]). ARBs were associated with a lower rate of the primary outcome among subgroups of male versus female participants, non‐Hispanic Black versus non‐Hispanic White participants, and those randomly assigned to standard versus intensive blood pressure ( P interaction : <0.01, 0.05, and <0.01, respectively). CONCLUSIONS In this secondary analysis of ACCORD‐BP and SPRINT, new users of ARB‐ versus ACEI‐based antihypertensive medication regimens experienced similar cardiovascular disease events rates, with important subgroup differences and lower rates of death overall. REGISTRATION URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01206062, NCT00000620.

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“…Freeman et al, (2020) Drug-resistant epilepsy, early-onset hypertension and white matter lesions: a hidden paraganglioma Silvennoinen et al, (2019) Effect of Intensive Blood Pressure Control on Carotid Morphology and Hemodynamics in Chinese Patients with Hyperhomocysteinemia-Type Hypertension and High Risk of Stroke Wu et al, (2019) Effect of intensive blood pressure control on subtypes of mild cognitive impairment and risk of progression from SPRINT study Gaussoin et al, (2022) Emergência hipertensiva e acidente vascular cerebral isquêmico e hemorrágico: conceitos atuais de tratamento Giannini et al, (2014) Equimolar doses of hypertonic agents (saline or mannitol) in the treatment of intracranial hypertension after severe traumatic brain injury Huang et al, 2020 Etiology, classification, and epidemiology of stroke Caplan, LR et al, (2016) Fatal intracranial haemorrhage in a hypertensive patient with atrial fibrillation and coronavirus disease 2019 ZONNEVELD et al, 2018). Como também, o uso do IECA e BRA contribuiu para redução do risco de resultados cognitivos ruins, demonstraram melhorar a memória episódica e as habilidades visuoespaciais (COHEN et al, 2022).…”

Section: Justificativamentioning

confidence: 99%

O Impacto E as Consequências Da Hipertensão Arterial No Acidente Vascular Cerebral

Vasconcelos¹,

Oliveira²,

Carneiro³

et al. 2023

RECIMA21

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O acidente vascular cerebral (AVC) é uma das complicações de maior impacto no mundo, devido a sua prevalência, morbidade e mortalidade, e na maioria dos casos há presença de fatores cardiovasculares, como a hipertensão arterial, que é o seu principal fator de risco modificável, podendo causar diferentes tipos de AVC, como infarto, hemorragia, AVCs grandes ou lacunares e as demências vasculares. O objetivo deste estudo foi analisar e discutir os impactos da hipertensão arterial e os seus fatores de risco que possam levar a um quadro de acidente vascular cerebral. Metodologia: Realizou-se uma revisão de literatura com busca sistemática, com objetivo de coletar e analisar informações atuais sobre esta temática, de forma que contribuiu para um direcionamento clínico, no qual foi utilizada a estratégia do acrônimo PICO. Resultados e discussão: Foram levantadas evidências que contribuíram no direcionamento clínico referente à influência da hipertensão arterial sistêmica no quadro de AVC em indivíduos acima de 50 anos.

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Risk of Mild Cognitive Impairment or Probable Dementia in New Users of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors

Cited by 5 publications

References 41 publications

Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer

Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer

New Users of Angiotensin II Receptor Blocker–Versus Angiotensin‐Converting Enzyme Inhibitor–Based Antihypertensive Medication Regimens and Cardiovascular Disease Events: A Secondary Analysis of ACCORD‐BP and SPRINT

O Impacto E as Consequências Da Hipertensão Arterial No Acidente Vascular Cerebral

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