Antihypertensives That Stimulate vs Inhibit Type 2 and 4 Angiotensin II Receptors Decrease Dementia
Marcum et al in JAMA New Open (2023) found that in “57,773 Medicare beneficiaries, initiation of antihypertensive medications that stimulate vs inhibit type 2 and 4 angiotensin II receptors was associated with a statistically significant 16% lower risk of incident dementia, over a median of 6.9 years of follow-up.”
“Angiotensin II receptor type 2 and 4–stimulating antihypertensive medications (hereafter, stimulating medications) included: Angiotensin II receptor type 1 blockers, dihydropyridine calcium channel blockers, and thiazide diuretics.
Angiotensin II receptor type 2 and 4–inhibiting antihypertensive medications (hereafter, inhibiting medications) included: angiotensin-converting enzyme (ACE) inhibitors, ?-blockers, and nondihydropyridine calcium channel blockers.”
Editors Note: If you have hypertension and are at risk for cognitive decline, know that your choice of effective antihypertensive drugs can lead to better cognitive outcomes. Drugs that stimulate the angiotensin II receptor type 2 and 4 help prevent dementia. These drugs include:
ARB type 1, dihydropyridine calcium channel blockers, and thiazide diuretics. (Good guys)
Those that inhibit Angiotensin II receptors types 2 and 4 do not prevent dementia. These drugs include:
ACE inhibitors, beta blockers, and non-dihydropyridine calcium channel blockers. (Bad guys)
Talk with your doc about drugs equally for blood pressure control but those that also have benefits for ultimate preservation of cognition.
Some Drugs for Hypertension Come with Greater Risk of Mood Disorders
Depression and bipolar disorder have been linked to atherosclerosis, the accumulation of fats, cholesterol, and plaques on the walls of the arteries. There is some evidence that drugs to treat hypertension may contribute to mood disorders. A large study published in the journal Hypertension in 2016 suggests that certain classes of anti-hypertensive drugs, calcium antagonists and beta blockers, may increase risk of mood disorders compared to other treatments for hypertension.
The study by researcher Angela H. Boal and colleagues used data from a hospital database to identify 144,066 patients between the ages of 40 and 80 who had taken anti-hypertensive drugs for more than 90 days. There was an independent linear connection between receiving a prescription for hypertenstion and being diagnosed with a mood disorder. Patients who took angiotensin-converting enzyme inhibitors or angiotensin receptor blocking drugs had the lowest rates of mood disorder admissions. Those taking calcium antagonists or beta blockers had an increased risk of a mood disorder, while those taking thiazide diuretics and those not taking anti-hypertensive drugs had no change in risk.
