Not applicable to us since they excluded stroke survivors from the trial. Our stroke leaders should initiate a trial on this for stroke survivors. That will never occur. No clue what the categories of stimulating or inhibiting contain.
Some antihypertensives may reduce risk for cognitive decline
Certain antihypertensive medications may help prevent cognitive decline, according to results of a cohort study published in JAMA Network Open.
“Although use of antihypertensive medications that stimulate (angiotensin II receptor type 1 blockers, dihydropyridine calcium channel blockers and thiazide diuretics) vs. inhibit (angiotensin-converting enzyme [ACE] inhibitors, beta-blockers and nondihydropyridine calcium channel blockers) type 2 and 4 angiotensin II receptors has been associated with lower risk of dementia, their association with cognitive outcomes in hypertension trials, with BP levels in the range of current guidelines, has not been evaluated,” Zachary A. Marcum, PharmD, PhD, associate professor in the department of pharmacy at the University of Washington, and colleagues wrote. “Examining this question in the context of contemporary BP levels can provide clinically relevant insights into antihypertensive associations with adjudicated cognitive outcomes, independent of their BP-lowering effects.
“Thus, we assessed the association of prevalent use of antihypertensive regimens that exclusively contain medications that stimulate vs. inhibit type 2 and 4 angiotensin II receptors on MCI or probable dementia in the Systolic Blood Pressure Intervention Trial (SPRINT),” they added.
Marcum and colleagues conducted the secondary analysis of individuals aged 50 years or older with hypertension and increased cardiovascular risk but no history of diabetes, stroke or dementia who participated in the randomized SPRINT Trial. As the exposure, they examined prevalent use of angiotensin II receptor type 2 and 4-stimulating or -inhibiting antihypertensive medication regimens at 6 months. A composite of adjudicated amnestic mild cognitive impairment or probable dementia served as the primary outcome.
A total of 8,685 participants prevalently used antihypertensive medication regimens at 6 months (mean age, 67.7 years; 64.3% men), of whom 2,644 (30.4%) used exclusively stimulating, 1,536 (17.7%) inhibiting and 4,505 (51.9%) mixed antihypertensive medication regimes.
Across a median of 4.8 years of follow-up, Marcum and colleagues noted 45 vs. 59 cases per 1,000 person-years of amnestic mild cognitive impairment or probable dementia among prevalent users of regimens featuring exclusively stimulating vs. inhibiting antihypertensive medications (HR = 0.76; 95% CI, 0.66-0.87). When they compared stimulating-only with inhibiting-only users, they found amnestic mild cognitive impairment rates of 40 vs. 54 cases per 1,000 person-years (HR = 0.74; 95% CI, 0.64-0.87) and probable dementia rates of eight vs. 10 cases per 1,000 person-years (HR = 0.8; 95% CI, 0.57-1.14). Further, they noted residual confounding, according to results of negative control outcome analyses.
“If these results are replicated in randomized clinical trials, certain antihypertensives could be prioritized to prevent the development of cognitive decline,” Marcum and colleagues wrote.
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