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Inhibiting Dementia With The Right ACE Inhibitors

July 27, 2009

According to a new study from Wake Forest University School of Medicine, published in Archives of Internal Medicine, a particular type of high blood pressure medication may protect older adults against memory decline and other impairments in cognitive function. "High blood pressure is an important risk factor for Alzheimer’s disease and vascular dementia," says Kaycee Sink, MD, MAS, lead author, geriatrician and 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." Many adults with 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. Included are the drugs captropril, fosinopril, lisinopril, perindopril, ramipril and trandolapril. Researchers looked at 1,074 participants who were free of dementia at the start of the study and who were being treated for hypertension. They 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. These participants saw an average 65 percent less cognitive decline per year of exposure compared to participants taking other blood pressure medications. In contrast, people taking non-centrally active ACE inhibitors were more likely to develop difficulty performing daily activities and had a 73 percent greater risk of developing dementia. Says Sink, "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."