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Risks of dementia and stroke in patients with hypertension using telmisartan or other renin‑angiotensin system
Chi-Hung Liu1,2,3, Ming-Lung Tsai2,4, Ning-I Yang2,5
1Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Insights
Telmisartan may offer a slight reduction in dementia and stroke risk for hypertension patients. This study compared telmisartan with other renin-angiotensin system inhibitors, finding potential cognitive and cerebrovascular benefits.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Hypertension (HTN) is a significant risk factor for cognitive decline and cerebrovascular events.
- Renin-angiotensin system (RAS) inhibitors are commonly prescribed for HTN management.
- Understanding the differential effects of various RAS inhibitors on cognitive and cerebrovascular outcomes is crucial.
Purpose of the Study:
- To investigate the long-term cognitive and cerebrovascular outcomes in patients with hypertension (HTN) treated with different renin-angiotensin system (RAS) inhibitors.
- To compare the risk of all dementias and all strokes among patients receiving telmisartan, non-telmisartan angiotensin receptor blockers (NT-ARB), and angiotensin-converting enzyme inhibitors (ACEI).
Main Methods:
- A cohort study involving 39,665 patients with HTN receiving long-term RAS inhibitor therapy.
- Patients were categorized into three groups: telmisartan, NT-ARB, and ACEI.
- Main outcomes assessed were the diagnosis of all dementias and the occurrence of all strokes during follow-up.
Main Results:
- The telmisartan group exhibited the lowest risk for all dementias compared to NT-ARB (HR: 0.78; 95% CI: 0.60-1.01) and ACEI (HR: 0.67; 95% CI: 0.48-0.94).
- A lower risk of all strokes was observed in the telmisartan group compared to NT-ARB (HR: 0.78; 95% CI: 0.61-0.99) in the time-dependent cohort.
- These findings suggest a potential benefit of telmisartan in reducing cerebrovascular events.
Conclusions:
- Telmisartan use may be associated with marginally lower risks of all dementia and stroke compared to other RAS inhibitors in patients with HTN.
- Further research is needed to clarify the specific impact of telmisartan on dementia risk in hypertensive patients with varying blood sugar levels.
Introduction:
The aim of this study was to investigate the cognitive and cerebrovascular outcomes of patients with hypertension (HTN) receiving various renin-angiotensin system (RAS) inhibitors.
Methods:
We further categorized 39,665 patients with HTN receiving long-term RAS inhibitor therapy into (1) telmisartan, (2) non-telmisartan angiotensin receptor blocker (NT-ARB), and (3) angiotensin-converting enzyme inhibitor groups. The main outcomes were a diagnosis of all dementias and the occurrence of all strokes during follow-up.
Results:
The telmisartan group had the lowest risk of all dementias (telmisartan vs NT-ARB: hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.60 to 1.01; telmisartan vs angiotensin-converting enzyme inhibitor: HR: 0.67; 95% CI: 0.48 to 0.94). The telmisartan group also had a lower risk of all strokes when compared to NT-ARB (HR: 0.78; 95% CI: 0.61 to 0.99) in the time-dependent cohort.
Discussion:
Use of telmisartan may be associated with marginally lower risks of all dementias and strokes compared to other RAS inhibitors in patients with HTN.
Highlights:
Whether telmisartan is associated with a reduced risk of dementia compared to other RAS inhibitors in patients with HTN and varying blood sugar levels remains unclear. Our cohort study aimed to investigate the long-term cognitive and cerebrovascular outcomes of hypertensive patients receiving telmisartan compared to those receiving other RAS inhibitors. Eligible individuals were categorized into three groups. Use of telmisartan may be associated with marginally lower risks of all dementia and stroke compared with other RAS inhibitors in patients with HTN.
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