OLDER ADULT USERS OF CENTRALLY ACTIVE AT-1 RECEPTOR BLOCKERS SHOW PRESERVED MEMORY

Abstract

Prior work suggests some but not all antihypertensive treatments may benefit cognition and risk for Alzheimer's disease, independent of stroke. Angiotensin II type 1 receptor blockers (ARBs) have been highlighted as one antihypertensive drug class that may confer greatest benefit. Participants were 1,626 non-demented adults, ages 55–91, recruited from Alzheimer's Disease Neuroimaging Initiative (ADNI) sites. Three groups were compared: ARBs users (HTN-ARBs), other-antihypertensive-drug-users (HTN-Other) and Normotensives. Post-hoc analyses also examined users of blood-brain-barrier (BBB)-crossing ARBs and users of non-BBB-crossing ARBs. Groups were compared on cognition, and MRI measures of brain volume and white matter hyperintensities, using ANCOVA and multilevel models. At baseline, the HTN-Other group performed worse than Normotensives on Rey Auditory Verbal Learning Test (AVLT) Immediate Recall (p=.002), Delayed Recall (p<.001), and Recognition memory (p=.001), and Trails A (p<.001) and B (p=.01). ARBs users performed better than the HTN-Other group on Recognition memory (p=.04) and worse than Normotensives on Trails A (p=.04). The HTN-Other group performed worse than Normotensives on Logical Memory Immediate (p=.02) and Delayed Recall over 3-year follow-up (p=.007). Over the follow-up period, those taking BBB-crossing ARBs performed better than the HTN-Other group on AVLT Delayed Recall (p=.04) and Logical Memory Immediate (p=.02) and Delayed Recall (p=.05). They also had fewer white matter hyperintensities (WMH) than the HTN-Other group (p=.008) and those on non-BBB-crossing ARBs (p=.05). There were no group differences in brain volume. Hypertensive participants demonstrated worse baseline memory and executive function, and greater memory decline over 3 year follow up compared to normotensives, unless they were ARBs users, who showed preserved memory compared to those on other antihypertensive drugs. Users of BBB-crossing ARBs showed superior memory performance over time compared to other antihypertensive drug users and had less WMH volume. Findings demonstrate that ARBs, especially those of the BBB-crossing variety, are associated with greater memory preservation and less WMH volume, when compared to other antihypertensive medications.