Alzheimer's, Dementia & Mental Health
ACE Inhibitors May Hold Down Dementia as Well as
Blood Pressure Says New Study
13 million may have dementia by 2050; delaying
dementia even one year would have a substantial impact on public health
July
23, 2009 – Someone in the U.S. is diagnosed with dementia every 70
seconds. Their memory decline may be slowed, however, by a class of
medication used to treat high blood pressure – ACE inhibitors. The
results from the Wake Forest University School of Medicine are published
in the current issue of Archives of Internal Medicine.
Research suggests that some of the drugs classified
as angiotensin-converting enzyme (ACE) inhibitors, specifically those
types of ACE inhibitors that affect the brain by crossing the
blood-brain barrier, may reduce inflammation that could contribute to
the development of Alzheimer's disease, a major cause of dementia.
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Alzheimer's, Dementia & Mental Health |
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"High blood pressure is an important risk factor
for Alzheimer's disease and vascular dementia," said Kaycee Sink, M.D.,
M.A.S., lead author of the study, geriatrician and an assistant
professor of internal medicine – gerontology.
"Our study found that all blood pressure
medications may not be equal when it comes to reducing the risk of
dementia in patients with hypertension."
Dementia is the broad term used to describe
conditions in the brain that cause loss of brain function. There are
several different causes of dementia, but Alzheimer's disease and
strokes are two of the most common.
People with dementia begin to lose
their memory and may not be able to think well enough to do normal
activities, such as getting dressed or eating, may lose their ability to
solve problems or control their emotions, may experience personality
changes and/or may become agitated or see things that are not there.
While memory loss is the hallmark of dementia, it
does not, by itself, mean an individual has dementia. People with
dementia have serious problems with two or more brain functions, such as
memory and problem solving.
It is estimated that the number of people in the
United States living with dementia will increase to about 13 million by
the year 2050. Therefore, delaying the onset of dementia, even by one
year, would have a substantial impact on public health.
Hypertension, or high blood pressure, is a major
contributor to the development of all types of dementia. Many of the
estimated one in three U.S. adults who have hypertension are treated
with ACE inhibitors, a class of drugs that help lower blood pressure by
causing the blood vessels to relax and widen.
Some ACE 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 ACE inhibitors include captropril
(Capoten®), fosinopril (Monopril®), lisinopril (Prinivil® or Zestri®),
perindopril (Aceon®), ramipril (Altace®) and trandolapril (Mavik®).
FamilyDoctor.org, the website of the American
Academy of Family Physicians, has a section on high blood pressure
medicines, which says there are eight types of high blood pressure
medicines. Following is their statement on ACE inhibitors.
“Angiotensin-converting enzyme inhibitors (also
called ACE inhibitors) keep your body from making angiotensin II, a
hormone that causes blood vessels to narrow. Some examples of ACE
inhibitors include benazepril (brand name: Lotensin), enalapril (brand
name: Vasotec), lisinopril (brand names: Prinivil, Zestril), quinapril
(brand name: Accupril), ramipril (brand name: Altace) and trandolapril
(brand name: Mavik).”
For the study, 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, N.C.; Sacramento County, Calif.; Pittsburgh, Pa.; and Washington
County, Md.
The investigators specifically looked at 1,074
study participants who were free of dementia when they entered the study
and who were being treated for hypertension. They evaluated whether
exposure to ACE inhibitors in general – and to the centrally-active
versus non-centrally active drugs – was related to dementia development
and cognitive decline.
Compared to other classes of anti-hypertensive
drugs, researchers found no association between exposure to ACE
inhibitors as a class and the risk of dementia. There was a significant
cognitive benefit, however, seen in those individuals treated with the
centrally-active ACE inhibitors specifically.
The study found an association 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. The
research showed that participants who were exposed to ACE inhibitors
that cross the blood-brain barrier saw an average 65 percent less
cognitive decline per year of exposure compared to participants taking
other blood pressure medications.
Researchers also found that non-centrally active
ACE inhibitors were associated with an increased risk of dementia and
the people taking them were more likely to develop difficulty performing
daily activities. Specifically, participants who, for three years, took
ACE inhibitors that do not cross the blood-brain barrier were at a 73
percent greater risk of developing dementia than were the individuals
taking other anti-hypertensive drugs.
"ACE inhibitors have been shown to be beneficial to
the heart and kidneys, and this study gives evidence that they may also
be beneficial to the brain—at least the ones that are able to get into
the brain," Sink said.
"We already know it is important to treat high
blood pressure and keep it under good control. But our study finds that
some blood pressure medications, such as the ACE inhibitors that cross
the blood brain barrier, may offer benefits to the brain that others do
not. If a patient has an indication for an ACE inhibitor, it makes sense
to choose one that crosses the blood brain barrier. This is quite
different from the typical recommendations for physicians to avoid
medications in older adults that get into the brain."
Background information
The research was supported by the National Heart,
Lung and Blood Institute, the Wake Forest University Pepper Older Adults
Independence Center, the Kulynych Center for Research in Cognition at
Wake Forest University, the Hartford Geriatrics Health Outcomes Research
Scholars Program, the National Institute of Neurological Disorders and
Stroke, and the National Institute on Aging.
Co-authors on the study were Xiaoyan Leng, Ph.D.,
Jeff Williamson, M.D., M.H.S., Stephen B. Kritchevsky, Ph.D., Hal
Atkinson, M.D., Mike Robbins, Ph.D., and David C. Goff, Jr., M.D.,
Ph.D., all from the School of Medicine, Kristine Yaffe, M.D., from the
University of California, Lewis Kuller, M.D., Dr.P.H., from the
University of Pittsburgh, Sevil Yasar, M.D., from Johns Hopkins
University, and Bruce Psaty, M.D., Ph.D., from the University of
Washington.
Wake Forest University Baptist Medical Center (www.wfubmc.edu)
says it is an academic health system comprised of North Carolina Baptist
Hospital, Brenner Children's Hospital, Wake Forest University
Physicians, and Wake Forest University Health Sciences, which operates
the university's School of Medicine and Piedmont Triad Research Park.
The system comprises 1,056 acute care, rehabilitation and long-term care
beds and has been ranked as one of "America's Best Hospitals" by U.S.
News & World Report since 1993. Wake Forest Baptist is ranked 32nd in
the nation by America's Top Doctors for the number of its doctors
considered best by their peers. The institution ranks in the top third
in funding by the National Institutes of Health and fourth in the
Southeast in revenues from its licensed intellectual property.
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Read more about Blood Pressure Medicines at FamilyDoctor.org
