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Prevention of dementia by antihypertensive drugs: how AT1-receptor-blockers and dihydropyridines better prevent dementia in hypertensive patients than thiazides and ACE-inhibitors.
Expert Rev Neurother. 2009 Sep; 9(9):1413-31.ER

Abstract

Our review of cohort studies and clinical trials evaluating antihypertensive drugs in the prevention of cognition decline and all dementia in patients with hypertension indicates that two antihypertensive drug classes have greater protective effects, independent of blood pressure decrease: dihydropyridine calcium-channel blockers as shown in the Syst-Eur trial and angiotensin-AT1 receptor blockers as found in the MOSES and ONTARGET trials. By contrast, diuretics and angiotensin-converting enzyme-inhibitors (ACEIs) prevent dementia only in patients with a stroke history, provided they are combined, and prevent stroke recurrence. A Japanese cohort study and a small trial in patients already suffering from Alzheimer's disease (AD) suggest, however, that the BBB-penetrating ACEI may slow down cognitive decline. Only cohort studies support the hypothesis that diuretics, (especially potassium-sparing diuretics), may decrease the risk of AD. beta-blockers worsen cognition decline, or are neutral, according to whether or not they cross the BBB. Centrally-acting sympatholytic agent have a negative impact on cognition as BBB-penetrating beta-blockers, probably by blunting the adrenergic pathways. The AD protective effect of DHP appears related to the blockade of neuronal calcium channels. The ambiguous effect of ACEI on cognitive decline and dementia prevention may be explained by the fact that brain ACE is not specific for angiotensin-I. Brain ACE also catabolizes cognition-enhancing brain peptides, amyloid peptides and converts toxic Abeta(42) into less toxic Abeta(40). Therefore, ACEIs may have short-term cognition-enhancing properties and may increase in the long term Abeta(42) brain burden and cognitive decline. The clinical relevance of this scenario, mainly observed in animals, cannot be excluded in man, since the ACE gene has been associated with AD via the human whole genome analysis. To support the hypothesized deleterious effect of ACEI on human AD, confirmation that the ACE gene polymorphism DD is associated with protection against AD is necessary, since this polymorphism increases ACE activity. Independently of their preventive impact on beta-amyloid degenerative neuropathological process by overexpressing insulin degrading enzyme which catabolyses amyloid, the angiotensin AT1-receptor-blockers may have greater cognition protective effects than ACEI (observed in the ONTARGET trial), as they share with ACEI cognition-enhancing effects directly linked with a common AT1-blunting effect. In addition, they increase angiotensin II and IV formation and therefore stimulate non-opposed AT2 and AT4 receptors, whose activation in cognitive processes is well established.

Authors+Show Affiliations

Internal Medicine Department, University Hospital, Amiens, France. fournier.albert@chu-amiens.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19769454

Citation

Fournier, Albert, et al. "Prevention of Dementia By Antihypertensive Drugs: How AT1-receptor-blockers and Dihydropyridines Better Prevent Dementia in Hypertensive Patients Than Thiazides and ACE-inhibitors." Expert Review of Neurotherapeutics, vol. 9, no. 9, 2009, pp. 1413-31.
Fournier A, Oprisiu-Fournier R, Serot JM, et al. Prevention of dementia by antihypertensive drugs: how AT1-receptor-blockers and dihydropyridines better prevent dementia in hypertensive patients than thiazides and ACE-inhibitors. Expert Rev Neurother. 2009;9(9):1413-31.
Fournier, A., Oprisiu-Fournier, R., Serot, J. M., Godefroy, O., Achard, J. M., Faure, S., Mazouz, H., Temmar, M., Albu, A., Bordet, R., Hanon, O., Gueyffier, F., Wang, J., Black, S., & Sato, N. (2009). Prevention of dementia by antihypertensive drugs: how AT1-receptor-blockers and dihydropyridines better prevent dementia in hypertensive patients than thiazides and ACE-inhibitors. Expert Review of Neurotherapeutics, 9(9), 1413-31. https://doi.org/10.1586/ern.09.89
Fournier A, et al. Prevention of Dementia By Antihypertensive Drugs: How AT1-receptor-blockers and Dihydropyridines Better Prevent Dementia in Hypertensive Patients Than Thiazides and ACE-inhibitors. Expert Rev Neurother. 2009;9(9):1413-31. PubMed PMID: 19769454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of dementia by antihypertensive drugs: how AT1-receptor-blockers and dihydropyridines better prevent dementia in hypertensive patients than thiazides and ACE-inhibitors. AU - Fournier,Albert, AU - Oprisiu-Fournier,Roxana, AU - Serot,Jean-Marie, AU - Godefroy,Olivier, AU - Achard,Jean-Michel, AU - Faure,Sebastien, AU - Mazouz,Hakim, AU - Temmar,Mohamed, AU - Albu,Adriana, AU - Bordet,Régis, AU - Hanon,Olivier, AU - Gueyffier,François, AU - Wang,Jiguang, AU - Black,Sandra, AU - Sato,Naoyuki, PY - 2009/9/23/entrez PY - 2009/9/23/pubmed PY - 2009/12/16/medline SP - 1413 EP - 31 JF - Expert review of neurotherapeutics JO - Expert Rev Neurother VL - 9 IS - 9 N2 - Our review of cohort studies and clinical trials evaluating antihypertensive drugs in the prevention of cognition decline and all dementia in patients with hypertension indicates that two antihypertensive drug classes have greater protective effects, independent of blood pressure decrease: dihydropyridine calcium-channel blockers as shown in the Syst-Eur trial and angiotensin-AT1 receptor blockers as found in the MOSES and ONTARGET trials. By contrast, diuretics and angiotensin-converting enzyme-inhibitors (ACEIs) prevent dementia only in patients with a stroke history, provided they are combined, and prevent stroke recurrence. A Japanese cohort study and a small trial in patients already suffering from Alzheimer's disease (AD) suggest, however, that the BBB-penetrating ACEI may slow down cognitive decline. Only cohort studies support the hypothesis that diuretics, (especially potassium-sparing diuretics), may decrease the risk of AD. beta-blockers worsen cognition decline, or are neutral, according to whether or not they cross the BBB. Centrally-acting sympatholytic agent have a negative impact on cognition as BBB-penetrating beta-blockers, probably by blunting the adrenergic pathways. The AD protective effect of DHP appears related to the blockade of neuronal calcium channels. The ambiguous effect of ACEI on cognitive decline and dementia prevention may be explained by the fact that brain ACE is not specific for angiotensin-I. Brain ACE also catabolizes cognition-enhancing brain peptides, amyloid peptides and converts toxic Abeta(42) into less toxic Abeta(40). Therefore, ACEIs may have short-term cognition-enhancing properties and may increase in the long term Abeta(42) brain burden and cognitive decline. The clinical relevance of this scenario, mainly observed in animals, cannot be excluded in man, since the ACE gene has been associated with AD via the human whole genome analysis. To support the hypothesized deleterious effect of ACEI on human AD, confirmation that the ACE gene polymorphism DD is associated with protection against AD is necessary, since this polymorphism increases ACE activity. Independently of their preventive impact on beta-amyloid degenerative neuropathological process by overexpressing insulin degrading enzyme which catabolyses amyloid, the angiotensin AT1-receptor-blockers may have greater cognition protective effects than ACEI (observed in the ONTARGET trial), as they share with ACEI cognition-enhancing effects directly linked with a common AT1-blunting effect. In addition, they increase angiotensin II and IV formation and therefore stimulate non-opposed AT2 and AT4 receptors, whose activation in cognitive processes is well established. SN - 1744-8360 UR - https://www.unboundmedicine.com/medline/citation/19769454/Prevention_of_dementia_by_antihypertensive_drugs:_how_AT1_receptor_blockers_and_dihydropyridines_better_prevent_dementia_in_hypertensive_patients_than_thiazides_and_ACE_inhibitors_ L2 - http://www.tandfonline.com/doi/full/10.1586/ern.09.89 DB - PRIME DP - Unbound Medicine ER -