Tuesday, July 14, 2009

Can ACE inhibitors Slow Cognitive Decline?

Well the answer is no... and maybe.

No, as a class ACE inhibitors can not slow the rate of cognitive decline. But, a subclass of ACE inhibitors that cross the blood-brain barrier may be helpful.

This comes from a study published in the most recent issue of the Achieves of Internal Medicine. We know that hypertension is a risk factor for dementia. We also have animal studies that suggest that centrally acting ACE inhibitors (those that cross the B-B barrier) may protect against dementia, above and beyond solely hypertension control.

ACE inhibitors that are categorized as centrally acting include:

● captropril (Capoten®)

● fosinopril (Monopril®)

● lisinopril (Prinivil® or Zestri®)

● perindopril (Aceon®),

● ramipril (Altace®)

● trandolapril (Mavik®)


Participants in the Cardiovascular Health Study Cognition Substudy with treated HTN and no diagnosis of congestive heart failure (n = 1054; mean age, 75 years) were followed up for a median of 6 years to determine whether cumulative exposure to ACE inhibitors (as a class and by central activity), compared with other anti-HTN agents, was associated with a lower risk of incident dementia, cognitive decline (by Modified Mini-Mental State Examination [3MSE]), or incident disability in instrumental activities of daily living (IADLs).

Among 414 participants who were exposed to ACE inhibitors and 640 who were not, there were 158 cases of incident dementia. Compared with other anti-HTN drugs, there was no association between exposure to all ACE inhibitors and risk of dementia. However, centrally active ACE inhibitors were associated with 65% less decline in 3MSE scores per year of exposure (P = .01).

CONCLUSION: As a class ACE inhibitors did not appear to slow the rate of cognitive decline. Centrally acting ACEi may be of benefit, but studies need to be repeated and confirmed with a randomized controlled trial on a larger scale.

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