Renin-angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease: analysis of data from the ONTARGET and TRANSCEND studies

Angiotensin-Receptor Blockers and Risk of Alzheimer’s Disease in Hypertension Population

“…Recent secondary analysis of the effects of RAS blockade on cognitive function in the doubleblind RCT ONTARGET study and its parallel TRANSCEND trial also showed no clear effects on cognitive outcomes. 25 In ONTARGET, cognitive impairment occurred in 652 (8%) of 7,865 patients treated with ramipril, in 584 (7%) of 7,797 treated with telmisartan, and in 618 (8%) of 7,807 with combination treatment, without significant difference in each of the groups. In TRANSCEND, the incidence of cognitive impairment was 9% in 2,694 participants receiving telmisartan, compared with 9% in 2,689 subjects with placebo [odds ratio (OR) 0.97, 0.81-1.17, P=0.76].…”

Drug Repositioning Approaches for the Discovery of New Therapeutics for Alzheimer's Disease

“…In vivo animal studies revealed that oral or intranasal administration of some ARBs, including valsartan, olmesartan, and losartan, reduced Aβ levels and ameliorated spatial learning and memory deficits in mouse models of Aβ pathology [111,112]. A few ARBs have also been clinically evaluated for their effect on cognitive function in a patient group with high risk of developing cardiovascular disease [113,114]. Overall results were largely found to be negative, at least for ramipril, telmisartan, and candesartan.…”

Prevention of Vascular Cognitive Impairment

“…240 In the PROGRESS trial treatment with perindopril with or without the addition of indapamide was associated with a reduced incidence of dementia in the subgroup of patients with recurrent stroke (risk reduction 23%; 3 -55%) and in patients receiving combination therapy (risk reduction 23%; 0 -41%). 252 However, in meta-analyses on all trials antihypertensive treatment had no significant effect on the risk of dementia, 236,250,259 cognitive impairment 236,249 or cognitive decline. 236,249 When stratifying trials according to drug classes a significantly reduced incidence of dementia was found in trials involving a diuretic or dihydropyridine calcium channel blocker (CCB) as part of active treatment whereas this was not the case in trials of renin system inhibitors.…”