Related Experiment Videos

Angiotensin receptor blockers and dementia risk in older adults: A target trial emulation

Hisashi Noma1,2,3, Hiroshi Sunada3, Taiki Sugimoto4

  • 1Department of Interdisciplinary Statistical Mathematics, The Institute of Statistical Mathematics, Tokyo, Japan.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|August 20, 2026
PubMed
Abstract

Insights

Angiotensin receptor blockers (ARBs) may reduce dementia risk compared to calcium channel blockers (CCBs) in older adults. This study found ARBs were associated with a modest decrease in overall dementia risk, especially vascular dementia.

Area of Science:

  • Gerontology
  • Pharmacology
  • Neurology

Background:

  • The impact of antihypertensive drug classes on dementia risk, independent of blood pressure reduction, is not fully understood.
  • Investigating drug-specific effects is crucial for optimizing dementia prevention strategies in hypertensive patients.

Purpose of the Study:

  • To compare the risk of dementia following the initiation of angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) in older adults.
  • To determine if ARBs offer a protective effect against dementia beyond their blood pressure-lowering capabilities.

Main Methods:

  • Emulation of a target trial using a nationwide Japanese database of dementia-free adults aged 65 years and older.
  • Weighted discrete-time hazards models were employed to estimate intention-to-treat and per-protocol effects, accounting for censoring and death.

Main Results:

  • Among 52,019 participants, ARB initiation was linked to a lower risk of all-cause dementia compared to CCB initiation (HR, 0.916; 95% CI, 0.852-0.985), with comparable blood pressure control.
  • The association was not statistically significant for Alzheimer's disease but was notably stronger for vascular dementia (HR, 0.617; 95% CI, 0.409-0.930).

Conclusions:

  • Initiation of ARBs was associated with a modest reduction in dementia risk compared to CCBs in older adults.
  • The findings suggest a potential benefit of ARBs, particularly in mitigating the risk of vascular dementia.
Keywords:
angiotensin receptor blockersbig data analysiscalcium channel blockersdementiareal‐world datatarget trial emulation

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