One Type of Blood Pressure Pill May Help Prevent Dementia

ACE-inhibitors (angiotensin converting enzyme inhibitors) are a class of high blood pressure medications that’s been around for about 25 years. They have a prominent place in the range of anti-hypertensive drugs available for the management of this condition. Now attention has again focused on the two types of ACE inhibitors – those that do and those that don’t pass across the blood-brain barrier. If the drug can get into the brain, it may possibly affect the brain’s intrinsic renin-angiotensin enzyme system, which is involved in memory and cognition. Along these lines, an article in the Archives of Internal Medicine describes the effect of ACE inhibitors on the development of dementia.

A study from Wake Forest University School of Medicine included 414 hypertensive patients who had taken ACE inhibitors and 640 who had taken other anti-hypertensive drugs. Their average age was 75 years. Cognitive decline, which was established using the Modified Mini-Mental State Exam (3MSE), was determined in 158 participants over a 6-year period.

There was no association between exposure to all ACE inhibitors and the risk for dementia. However, when the centrally-active ACE inhibitors alone were considered, there was 65% less decline in cognitive function scores per year of drug exposure. Non-centrally active ACE inhibitors were associated with a greater risk of dementia, compared with non-ACE antihypertensive drugs. An added finding was that taking a non-centrally active ACE inhibitor was linked to an increased risk of developing difficulty performing daily activities.

Centrally-active ACE inhibitors (i.e. those that cross the blood-brain barrier) include captopril (Capoten®), lisinopril, perindopril, and ramipril (Altace®). Non-centrally active ACE inhibitors include enalapril (Vasotec®), quinapril (Accupril®), and benazepril (Lotensin®).

It now seems appropriate to study one of the centrally-active ACE inhibitors in a randomized clinical trial in the prevention of dementia. In the meantime, should patients switch their ACE inhibitor medications? Remember that the doctor had a reason for the original choice of medication, so any change should be discussed with the prescribing physician. However, unless there’s a good reason, a switch to a centrally-acting drug makes good sense.