Not All Blood Pressure Drugs Equal for Dementia

 With your risk of dementia post stroke, you do expect your competent? doctor not to make it worse by not knowing of this! 

With your risk of dementia, you need this.

Parkinson’s Disease May Have Link to Stroke March 2017 

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018

The latest here:

Not All Blood Pressure Drugs Equal for Dementia

Some antihypertensive drugs are better than others for reducing the risk of developing biomarkers of dementia, according to new research published in JAMA Network Open.

The autopsy cohort study found that angiotensin II receptor stimulating drugs were associated with lower levels of a biomarker for Alzheimer’s disease in several brain regions than drugs that inhibit angiotensin II. The risk reductions ranged from 14% to 21%.

Most notably, use of these drugs for 15 years or more was associated with a 24% lower risk for arteriolosclerosis. Angiotensin II is a hormone responsible for controlling blood pressure by constricting blood vessels.

“It’s better for the brain to have one flavor of drug than another in terms of dementia risk, cognition, and neuropathology,” said Paul Crane, MD, MPH, professor of medicine at the University of Washington in Seattle, who helped author the study.

But he said clinicians should not make prescription choices based on these findings and instead look to future guidelines that might recommend a drug class over another.

For the biomarker study, Crane and colleagues analyzed data from a cohort of 756 patients (mean age at death, 89.2 years; 93.9% White) who participated in ongoing prospective research that began in 1994 and had since died. They evaluated cumulative and long-term (over 15 years) use of the antihypertensive medications. The authors noted the study population was predominantly well educated.

Angiotensin II-stimulating drugs were linked to lower levels of several markers of neurodegeneration — including neocortical Lewy bodies and arteriolosclerosis — than angiotensin II-inhibiting drugs. They also observed 14%-21% lower levels of the tau biomarker in those who received the stimulating drugs.

No significant differences were observed in amyloid-beta 42, a biomarker for Alzheimer’s disease, between the regimens.

Current Guidance

Last year, the American Heart Association (AHA) and the American College of Cardiology (ACC) issued a new joint guideline for the prevention and management of high blood pressure. They noted that observational studies and clinical trials suggest improved control of systolic blood pressure reduces Alzheimer’s disease and related dementia.

They recommended initial first-line medications for treatment of primary hypertension in this patient population but did not recommend specific treatments that could prevent or slow dementia.

Crane said his study could influence guidelines in the future.

“If the guideline writers were on the fence” about choosing an antihypertensive, the data “might be a tiebreaker,” Crane said.

Daniel Jones, MD, chair of the AHA/ACC guideline writing committee and dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi, said the new study may be useful for generating hypotheses for future clinical trials, but it “is not possible to draw firm conclusions relevant to clinical practice” because of its retrospective nature.

Josef Coresh, MD, PhD, founding director of the Optimal Aging Institute at the NYU Grossman School of Medicine in New York City, said the new study adds to a growing body of research showing blood pressure control is linked to dementia.

“This pathology study supports the growing evidence of the importance of blood pressure control for brain health and, importantly, the ability to prevent cognitive impairment and dementia,” he said.

Other studies also have found that drugs that stimulate angiotensin II have beneficial effects on the brain, including a 25% lower risk for mild cognitive impairment or probable dementia at 5 years of follow-up. A 2025 systematic review and meta-analysis showed that use of stimulating medications reduced the risk for all-cause dementia by 13% compared with inhibiting antihypertensives.

Ariel Cole, MD, program director for geriatric fellowship at AdventHealth in Orlando, Florida, said the study raises several questions, including how much cognitive impairment participants had at the time of death and whether hypertension was managed differently between the two types of drugs.

She said she does not expect the findings to influence the prescribing practices of family and primary care physicians.

“One study rarely is enough to change practice,” she said.

Crane reported receiving research funding from the National Institutes of Health. Cole, Jones, and Coresh reported having no financial conflicts of interest.

Brenda Sandburg is a freelance journalist for Medscape Medical News. She has written about the biopharmaceutical industry and legal issues for the Pink Sheet and American Lawyer Media.