New research in The Lancet highlights the anti-dementia effects of commonly prescribed blood pressure meds. The paper, published in May 2024, describes how researchers dredged 34 years’ worth of Dutch medical records to confirm the link. In an enormous cohort study, the researchers confirmed that widely used medications such as calcium channel blockers and angiotensin receptor blockers can lower the risk of dementia by up to 30%, compared to other antihypertensive drugs.
Hypertension Can Contribute to Dementia
Doctors have long known that high blood pressure contributes to dementia. If you keep your heart and circulatory system healthy, your brain will also benefit. With that in mind, it might sound obvious that using medicine to lower your blood pressure would also lower your chances of developing dementia. Amsterdam-based researchers say that there’s more to this effect, however, than meets the eye. It turns out that certain types of antihypertensive drugs may have a direct effect on brain health in addition to their blood pressure regulating role.
Dr Jakob Schroevers, the first author of the 2024 Lancet study, explained to Medical News Bulletin that the link between blood pressure medication and dementia had been noted by several research groups. “Elevated blood pressure damages blood vessels, including those in the brain, leading to oxygen deprivation, and subsequent damage to the brain tissue surrounding it, sometimes unnoticed. This damage to brain tissue may contribute to various forms of dementia, including Alzheimer’s disease. Treating elevated blood pressure has been shown to lower dementia risk, with some type of blood pressure – lowering medications potentially reducing dementia risk more than others.”
Which Meds Help Most?
What was not well understood, however, was whether it mattered which medication you used and how big the effect was. A large-scale study, he says, was needed to tease out an answer to the question, “are some blood pressure drugs better than others when it comes to reducing the risk of dementia”? With his colleagues at Amsterdam UMC, Schroevers sifted through the anonymized medical records of over 130,000 people in the Netherlands. While previous research had spotted the link between lowering blood pressure and reducing the incidence of dementia, the picture was murky due to small sample sizes over limited time periods. What’s more the, lack of clarity over who used which medicine and for how long made statistical predictions about risk technically challenging.
Schroevers explains, “We had access to a very large population of community-dwelling individuals, enabling us to detect even subtle differences in risk and draw conclusions applicable to a wider audience, thus enhancing the reliability of our findings.” He continues, “we had access to many years of data per patient, which was crucial given the slow development of dementia; this allowed us to observe differences in dementia risk associated with different types of BP-lowering medications over time. ” With access to eight million prescription records, the team were able to fathom the subtle changes in risk profile that could result from patients changing up their prescriptions.
Nationwide Investigation
The nationwide cohort study probed anonymized Dutch medical records to identify patients who had been prescribed antihypertensive drugs. They collected information for every identified case and carefully accounted for the effects that sex, age, history of heart attack, history of stroke, diabetes and congestive heart failure could have on a person’s likelihood of developing dementia.
The large number of people included in the study allowed the researchers to measure the effects that these confounding variables might have on patient outcomes. Diabetes, heart failure, stroke and myocardial infarction can increase the risk of dementia, and so might hide the anti-dementia effects of the medications. They were also able to incorporate mortality into their studies. Some researchers had wondered if it looked like patients using antihypertensives were less likely to get dementia because they were sicker and died earlier than their heart healthy peers. They also accounted for the effects of people changing up their medications and switching between different classes of antihypertensive.
The Results Are In
Once the researchers had a handle on the data, they compared the outcomes of people who took different types of antihypertensive medications to see which worked better at reducing a person’s risk of developing dementia. The researchers confirmed that continued use of antihypertensive medications of all kinds staved off dementia for a few more years than patients who stopped taking their medicine. Antihypertensive medication, angiotensin II receptor blockers1, calcium channel blockers2, beta blockers and thiazide diuretics3 reduced the risk of dementia compared to angiotensin-converting enzyme inhibitors.4
Schroevers tells us, “Our findings are consistent with some previous studies that identified differences between types of BP-lowering medications. The consistent link between angiotensin receptor blockers (ARBs) with lower dementia risk compared to angiotensin-converting enzyme (ACE) inhibitors is particularly intriguing. This is because both these types of BP-lowering medication are commonly prescribed to similar patient groups with high BP, including those who additionally have diabetes.” Diuretics and calcium channel blockers had the best anti-dementia effects but people who used angiotensin II receptor blockers lived for longer.
Changes On the Way?
Currently angiotensin-converting enzyme inhibitors are widely prescribed to people who have high blood pressure, especially if they have also experienced a stroke or heart attack. With similar safety profiles and efficacy to other antihypertensive drugs, this could just be down to habit. Angiotensin Converting Enzyme inhibitors (ACE i) have been around for a long time and are often the first medication that comes to mind when a GP prescribes for high blood pressure. If there are no other considerations, choosing alternatives to ACE i medications could be a simple way to bring down a patient’s risk of dementia.
An interesting aspect of this work is that ACE i drugs had significantly smaller effect on dementia risk than did any of the other drugs. The authors of the study speculate that calcium channel blockers and angiotensin receptor blockers might also help neurons in the brain stay healthy for longer independently of their effects on blood vessels.
Time For a Prescription Review
While these results are very useful, it is not time to chuck out your ACE i meds in favour of beta blockers. What is needed now is a randomized controlled trial to directly test the anti-dementia effects of each drug and to accurately compare their outcomes. With so many factors that can obscure the effects of these drugs, we are still looking at a fuzzy picture. On the other hand, all things being equal it can’t hurt to ask your GP what they think a good drug regime could be for you.
As Schroevers says, “Blood Pressure-lowering drugs reduce dementia risk in patients with elevated Blood Pressure, certain types potentially more effectively than others. However, further research is needed to confirm these differences before Blood Pressure-treatment guidelines may be changed. Meanwhile, while there is no cure for dementia yet, adopting a healthy lifestyle, including a balanced diet, maintaining a healthy weight, and managing blood pressure can lower the risk of various diseases, including dementia, empowering individuals to take control of their health.”
Many thanks to Dr JL Schroevers for his generosity with his time.
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Schroevers JL, Hoevenaar-Blom MP, Busschers WB, et al. Antihypertensive medication classes and risk of incident dementia in primary care patients: a longitudinal cohort study in the Netherlands. The Lancet Regional Health – Europe. 2024;42. doi:10.1016/j.lanepe.2024.100927
- examples include azilsartan (Edarbi) candesartan (Atacand) eprosartan mesylate (Teveten) ↩︎
- examples include benzothiazepines (diltiazem); phenylalkylamines (verapamil); and the dihydropyridines (amlodipine, bepridil, felodipine, isradipine, nicardipine, nifedipine, and nisoldipine). ↩︎
- examples include hydrochlorothiazide (HCTZ), chlorthalidone, and indapamide3 ↩︎
- examples include Benazepril (Lotensin), Captopril, Enalapril (Vasotec), Fosinopril, Lisinopril (Zestril), Moexipril, Perindopril, Quinapril. ↩︎
