Association between centrally active angiotensin‐converting enzyme inhibitors with dementia risk

Background Hypertension is a well-established risk factor for dementia and antihypertensive treatments could be important disease prevention. Observational animal studies suggest Angiotensin-Converting Enzyme Inhibitors (ACEIs) are associated with reduced whereas genetic show these drugs increase risk. One plausible explanation of this heterogeneity that not all ACEIs cross the blood–brain barrier (BBB) their association may depend on whether or specific molecule crosses blood brain barrier. We investigated centrally vs non-centrally active incident compared using medical records from USA (OPTUM). Methods This retrospective new-user comparative cohort study patients ≥50 years old hypertension who were new users (captopril, fosinopril, lisinopril, perindopril, ramipril, trandolapril; n = 327,663 (n 30,867) (benazepril, enalapril, moexipril, quinapril). Patients followed up to 10 (2006-2018) during which 11,422 cases diagnosed. Stratified Cox proportional hazards models used estimate hazard ratio (HR) incidence all-cause sub types over follow period, controlling age, demographics such as geographic location other comorbidities stroke, myocardial infarction diabetes. Results In unadjusted adjusted models, had slightly greater cause vascular but Alzheimer’s disease. HR 1.08 (95% CI 1.01-1.15), 1.34 1.13-1.60) 1.00 0.90-1.12) dementia, respectively. Whereas 1.16 1.09-1.24), 1.35 1.12-1.62) 1.10 0.98-1.23) Conclusions Our results potentially indicate higher ACEIs. work supports causal genetics links between ACE inhibitors in increased Future will investigate drug classes differ based penetrating ability.