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Alzheimer's, Dementia & Mental Health
Choose an ACE Inhibitor for Hypertension that also
Fights Alzheimer's
New study says some of these drugs reduce memory loss
in seniors
May 8, 2007 – If you need to take an ACE inhibitor
to fight high blood pressure, a new study says you should get one that
seems to protect senior citizens from declines in memory and other
cognitive function. These special drugs may also provide some protection
from Alzheimer's disease.
The drugs that researchers believe are protective
are part of a class known as ACE inhibitors – specifically those types
that reach the brain and may help reduce the inflammation that might
contribute to Alzheimer's disease.
This new research from Wake Forest University
School of Medicine was reported recently at the annual meeting of the
American Geriatrics Society in Seattle.
"For older adults who are going to take an ACE
inhibitor drug for blood pressure control, it makes sense for their
doctors to prescribe one that goes into the brain," said Kaycee Sink,
M.D., M.A.S., lead researcher and an assistant professor of internal
medicine – gerontology.
Some ACE (angiotensin-converting enzyme) inhibitors
are known as centrally acting because they can cross the blood brain
barrier, a specialized system of tiny blood vessels that protects the
brain from harmful substances in the blood stream. Centrally acting
drugs include
● captropril (Capoten®),
● fosinopril (Monopril®),
● lisinopril (Prinivil® or Zestri®),
● perindopril (Aceon®),
● ramipril (Altace®) and
● trandolapril (Mavik®).
The study found a link between taking centrally
active ACE inhibitors and lower rates of mental decline as measured by
the Modified Mini-Mental State Exam, a test that evaluates memory,
language, abstract reasoning and other cognitive functions.
For each year that participants were exposed to ACE
inhibitors that cross the blood brain barrier, the decline in test
results was 50 percent lower than the decline in people taking other
kinds of high blood pressure pills.
The researchers also found that non-centrally
active ACE inhibitors were associated with a trend towards an increased
risk of dementia. However, the results were not statistically
significant, which means that they could have occurred by chance.
Dementia was diagnosed by a panel of physicians after reviewing results
of magnetic resonance imaging and other tests.
"These results suggest that there is more to
treating blood pressure than achieving a goal of 140/80," said Sink.
"Which drug you choose for blood pressure control can have broader
implications. We know that ACE inhibitors protect against heart failure
and kidney failure, and now there is evidence that some of them may also
protect against dementia."
Sink said the effects may be related to reducing
inflammation in the brain.
"The hypothesis for how they may slow cognitive
decline is that they are decreasing inflammation in the brain, and we
know that inflammation is important in the development of Alzheimer's
disease," she said.
The researchers analyzed data from the
Cardiovascular Health Study, a long-term study of cardiovascular risk
factors that involved 5,888 people over 65 years old from Forsyth County
in North Carolina, Sacramento County, Calif., Pittsburgh, Pa., and
Washington County, Md. The mean age of participants was 75 years old and
most participants (64 percent) were women.
They specifically looked at 1,074 study
participants who were free of dementia when they entered the study and
who were being treated for high blood pressure. They evaluated whether
exposure to ACE inhibitors in general – and to the centrally active
versus non-centrally active drugs – was related to dementia and
cognitive decline.
Compared to other anti-hypertensive drugs, there
was no association between exposure to ACE inhibitors as a class and the
risk of dementia. The benefits clearly came from taking the centrally
active drugs.
"We need to confirm the results in a study in which
people are randomly selected to receive either ACE inhibitors that are
centrally active or those that aren't," said Sink. "Hypertension is a
risk factor for dementia, so it's important to know if the type of drug
pressure medication a person takes can cut that risk."
Editor's Notes:
The research is supported by the National Heart,
Lung and Blood Institute, the Pepper Older Adults Independence Center,
and the Hartford Geriatrics Health Outcomes Research Scholars Program.
Co-researchers were Xiaoyan Leng, Ph.D., Jeff Williamson, M.D., M.H.S.,
Steve Kritchevsky, Ph.D., Hal Atkinson, M.D., Mike Robbins, Ph.D., and
David Goff, M.D., Ph.D., all from Wake Forest, Kristine Yaffe, M.D.,
from the University of California, Bruce Psaty, M.D., Ph.D., from the
University of Washington, Lewis Kuller, M.D., Dr.P.H., from the
University of Pittsburgh, and Sevil Yasar, M.D., from Johns Hopkins
University.
Wake Forest University Baptist Medical Center is
an academic health system comprised of North Carolina Baptist Hospital
and Wake Forest University Health Sciences, which operates the
university's School of Medicine. U.S. News & World Report ranks Wake
Forest University School of Medicine 18th in family medicine, 20th in
geriatrics, 25th in primary care and 41st in research among the nation's
medical schools. It ranks 35th in research funding by the National
Institutes of Health. Almost 150 members of the medical school faculty
are listed in Best Doctors in America.
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