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Angiotensin-converting enzyme inhibitors: a therapeutic option for controlling blood pressure associated with delayed
Michel Ferreira Machado1, Henrique Cotchi Simbo Muela2, Valeria Aparecida Costa-Hong2
1Department of Neurology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. michelfmachado83@gmail.com.
Insights
Antihypertensive treatment is crucial for preventing cognitive decline. This study found that hypertensive patients had worse cognitive performance, and specific antihypertensive drugs like ACE inhibitors negatively impacted processing speed.
Area of Science:
- Neurology
- Pharmacology
- Gerontology
Background:
- Hypertension is a significant risk factor for cognitive decline.
- Antihypertensive treatment (AT) is vital for mitigating hypertension-related cognitive impairment.
- The specific impact of different antihypertensive drugs (AHDs) on cognitive performance (CP) requires further investigation.
Purpose of the Study:
- To compare cognitive performance between non-hypertensive volunteers and hypertensive patients.
- To evaluate the correlation between cognitive performance and the use of specific antihypertensive drugs.
- To explore the mechanisms of AT on cognition beyond blood pressure reduction.
Main Methods:
- An observational study involving three groups: non-hypertensive (NH), controlled hypertensive, and uncontrolled hypertensive.
- A neuropsychological battery was used to assess cognitive domains, with performance transformed into z-scores.
- Linear regression models analyzed the association between AHD use and cognitive performance, particularly processing speed (PS).
Main Results:
- Hypertensive groups were older and exhibited poorer CP in episodic memory, language, and processing speed compared to NH individuals.
- Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were the most common AHDs.
- A negative association was found between PS and ACEi use, suggesting a drug-specific effect on cognition.
Conclusions:
- Antihypertensive treatment's effect on cognition involves more than just lowering blood pressure, with AHD mechanisms playing a role.
- Adaptations in AT regimens may offer additional cognitive benefits, even in patients without overt cognitive impairment.
- Further research into AHD mechanisms is warranted to optimize cognitive outcomes in hypertensive patients.
Abstract:
Antihypertensive treatment (AT) is essential for preventing hypertension-related cognitive decline. The goals of this observational study were to compare cognitive performance (CP) between non-hypertensive (NH) volunteers and hypertensive patients and to evaluate the correlation between CP and antihypertensive drugs (AHD). Three groups were constituted: NH (n = 30) [group 1], hypertensive with systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg (n = 54) [group 2] and hypertensive with SBP ≥ 140 or DBP ≥ 90 (n = 31) [group 3]. To analyze the cognitive domains, a neuropsychological battery was applied and the raw performance values in these tests were transformed into z-scores. The domain was considered impaired if it presented a z-score below -1.5 SD. Compared to group 1, both groups of hypertensive were older (51 [ ± 12] years) and showed a worse CP in episodic memory (p = 0.014), language (p = 0.003) and processing speed (PS) [p = 0.05]. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) were the most used AHD (46.3%, p = 0.01 [group 2] and 64.5%, p = 0.005 [group 3]) and showed correlations with PS. Linear regression models revealed a negative association of PS with the use of ACEi (β = -0.230, p = 0.004), but not with the use of ARB (β = 0.208, p = 0.008). The effect of AT on cognition appears to go beyond the search for lower blood pressure targets and also includes the mechanism of action of AHD on the brain, so that additional benefits may possibly be achieved with simple adaptations in the treatment regimen, particularly in patients without clinically manifest cognitive impairment.
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