Alzheimer's, Dementia & Mental Health
Alzheimer's Disease Risk Drops 50 Percent in Elderly
Taking a Blood Pressure Medicine
Extensive studies show high blood pressure is major
risk factor for dementias including AD; previous research suggests drugs
to control blood pressure had a protective effect on the brain
Oct. 17, 2013 - Elderly Americans with normal
cognition saw their risk of Alzheimer's Disease dementia drop by over 50
percent after taking a blood pressure medication. Those with mild
cognitive impairment saw their risk drop by 50 percent after taking
A Johns Hopkins-led analysis of data previously
gathered on more than 3,000 elderly Americans "strongly suggests" that
taking certain blood pressure medications to control blood pressure may
reduce the risk of dementia due to Alzheimer's disease (AD).
In a report published in a recent edition of the
journal Neurology, a team of researchers found that people over
the age of 75 with normal cognition who used diuretics, angiotensin-1
receptor blockers (ARBs) and angiotensin-converting enzyme (ACE)
inhibitors showed a reduced risk of AD dementia by at least 50 percent.
In addition, diuretics were associated with 50
percent reduced risk in those in the group with mild cognitive
Beta blockers and calcium channel blockers did not
show a link to reduced risk, the scientists reported.
"Identifying new pharmacological treatments to
prevent or delay the onset of AD dementia is critical given the dearth
of effective interventions to date," says the author, Sevil Yasar, M.D.,
Ph.D., assistant professor of medicine in the Department of Geriatric
Medicine and Gerontology at the Johns Hopkins University School of
"Our study was able to replicate previous findings,
however, we were also able to show that the beneficial effect of these
blood pressure medications are maybe in addition to blood pressure
control, and could help clinicians in selecting an antihypertensive
medication based not only on blood pressure control, but also on
Alzheimer's disease is a rapidly increasing
clinical and public health issue in the United States' aging population,
and the most common cause of intellectual and social decline.
Yasar and her colleagues conducted a "post-hoc"
analysis of information gathered originally in the so-called Ginkgo
Evaluation of Memory Study (GEMS) study, a six-year effort to determine
if use of the herb ginkgo biloba reduced AD risk.
That study , a double-blind, randomized, controlled
clinical trial of 3,069 adults without dementia, aged between 75 and 96
years, began in 2000 and recruited participants from four U.S. cities:
Hagerstown, Md.; Pittsburgh, Pa.; Winston-Salem/Greensboro, N.C.; and
Yasar said that while the GEMS trial showed no
benefit of ginkgo biloba in reducing incidence of dementia, information
was also available among the study participants related to their use of
several classes of antihypertensive drugs. Extensive studies suggest
that high blood pressure is a major risk factor for dementias including
AD, and there had been suggestions that drugs used to control blood
pressure conferred a protective effect on the brain in addition to
controlling blood pressure.
The question, she said, was which ones were
associated with reduced AD dementia risk, and which were not.
Yasar and colleagues looked at 2,248 of the GEMS
subjects, of them 351 reported use of a diuretic, 140 use of ARBs, 324
use of ACE inhibitors, 333 use of calcium channel blockers and 457 use
of beta blockers. The average age of this group was 78.7 years, and 47
percent were women.
"We were able to confirm previous suggestions of a
protective effect of some of these medicines not only in participants
with normal cognition, but also in those with mild cognitive
impairment," says Yasar.
"Additionally, we were also able to assess the
possible role of elevated systolic blood pressure in AD dementia by
placing those within each medication group in categories above and below
systolic blood pressures of 140 mmHg, the standard cut-off reading for a
diagnosis of hypertension," she said.
Yasar cautioned that the analysis had its
limitations, owing mostly to the fact that the data collected by the
GEMS trial were not gathered to directly measure the effect of the
drugs, and by the fact that it was impossible to tell with certainty how
well each group of participants complied with their drug treatments. Nor
did the research team have information on subjects' use of drugs prior
to the study period.
But, she said, "the consistent pattern we saw of
reduced risk of AD dementia associated with these medications warrants
further studies, including the use of brain imaging, to better
understand the biologic basis of these associations."
Such studies, she added, "could lead to
identification of new pharmacologic targets for preventive interventions
to slow cognitive decline and possibly delay progression of AD
Other Johns Hopkins investigators who authored the
study include Jin Xia, M.S.; Wenliang Yao, Ph.D.; Qian-Li Xue, Ph.D.;
and Michelle C. Carlson, Ph.D. Additional researchers include Curt D.
Furberg, M.D., Ph.D.; Carla I. Mercado, Ph.D.; Annette L. Fitzpatrick,
Ph.D.; Linda P. Fried, M.D.; Claudia H. Kawas, M.D.; Kaycee M. Sink,
M.D.; Jeff D. Williamson, M.D.; and Steven T. DeKosky, M.D. The research
team included scientists from Wake Forest School of Medicine
(Winston-Salem, N.C.), University of Washington (Seattle, Wash.),
Columbia University (New York, N.Y.), University of California, Irvine
(Irvine, Calif.), University of Pittsburgh (Pittsburgh, Pa.) and
University of Virginia (Charlottesville, Va.).
The study was supported by the Ginkgo Evaluation of
Memory (GEM) Study; the National Center for Complementary and
Alternative Medicine (NCCAM); the Office of Dietary Supplements; the
National Institute on Aging; the National Heart, Lung, and Blood
Institute; the University of Pittsburgh Alzheimer's Disease Research
Center; and the National Institute of Neurological Disorders and Stroke.
Yasar has been funded by NIH and received research
support from the John A. Hartford Foundation, the Nathan Shock Memorial
Fund, the drug company Sanofi and families of grateful patients. She
served as a consultant for the Charles River Company.
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Johns Hopkins Department of Geriatric Medicine and Gerontology
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