P3-011: Antihypertensive drug use modulates progression of Alzheimer's disease

Abstract

Some antihypertensive drugs are considered to decrease the incidence of AD or slow Alzheimer's disease (AD) progression although some studies for antihypertensive drugs resulted in no effect on AD. In antihypertensive drugs, angiotensin converting enzyme inhibitors (ACE-Is) have had attention in Alzheimer's disease progression because the renin angiotensin system plays an important role in brain functions especially in cognition and learning. Our group previously presented that some brain-penetrating ACE-Is can slow the rate of cognitive decline in mild-to-moderate AD patients with hypertension (Ohrui et al. Neurology, 2004). We examined mini mental state examination (MMSE) scores every year for 2 years during exposure to one of the antihypertensive drugs to study medications. Patients with mild to moderate AD were recruited from outpatient clinics. Patients eligible for this study had a diagnosis of mild to moderate AD, were aged 64 years and older, had MMSE scores within the range of 18 to 27, and had a blood pressure of higher than 140 mmHg systolic or 90 mmHg diastolic. The diagnosis of probable AD was made according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria with no clinical or laboratory evidence of a cause other than AD for dementia. We screened 114 AD patients with hypertension taking an antihypertensive drug. All the patients examined took donepezil (5 mg/day) every day. The decrease in MMSE score was significantly smaller in groups taking angiotensin II type-2 receptor blockers (ARBs) or brain -penetrating ACE-Is than in groups taking non-brain penetrating ACE-I or calcium channel blockers. We concluded that the use of ARBs and brain-penetrating ACE-Is could be beneficial to manage AD patients with hypertension to slow the progression of dementia. Therefore physicians should be more careful in choosing antihypertensive drug for AD patients with hypertension.