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ACE inhibitors, angiotensin 2 receptor blockers, calcium channel blockers, and diuretics, and each reduce blood pressure while crossing the blood-brain barrier and impacting cognitive function.
New research from the American Heart Association found that older adults taking blood pressure-lowering medications known to cross the blood-brain barrier had better memory recollection over time versus those taking other types of medicines to treat high blood pressure, as published in the journal Hypertension.
Blood pressure-lowering medicines include ACE inhibitors, angiotensin 2 receptor blockers (ARBs), calcium channel blockers, and diuretics, and each class of these medicines acts differently to reduce blood pressure while crossing the blood-brain barrier and impacting cognitive function.
“Research has been mixed on which medicines have the most benefit to cognition,” said study author Daniel A. Nation, PhD, in the press release. ”Studies of angiotensin II receptor blockers and angiotensin-converting-enzyme (ACE) inhibitors have suggested these medicines may confer the greatest benefit to long-term cognition, while other studies have shown the benefits of calcium channel blockers and diuretics on reducing dementia risk.”
According to the press release, this is the first meta-analysis to compare the potential impact over time of blood pressure lowering medicines that do compared to those that do not cross the blood-brain barrier. The medicines were then evaluated for their effects on several cognitive domains, including attention, language, verbal memory, learning, and recall.
“Hypertension occurs decades prior to the onset of dementia symptoms, affecting blood flow not only in the body but also to the brain,” Nation said in the press release. “Treating hypertension is likely to have long-term beneficial effects on brain health and cognitive function later.”
The research team gathered information from 14 studies consisting of approximately 12,900 adults from 50 years of age and older, including studies done in the United States, Australia, Canada, Germany, Ireland, and Japan.
A highlight of the study was that older adults who took blood pressure-lowering medicines that cross the blood-brain barrier had better memory recall for up to 3 years of follow-up compared to those taking medicines that do not cross the blood-brain barrier, even with a higher level of vascular risk. Further, adults who were taking hypertension medications that did not cross the blood-brain barrier had improved their attention span for up to 3 years of follow-up, according to the press release.
“These findings represent the most powerful evidence to-date linking brain-penetrant ACE-inhibitors and angiotensin receptor blockers to better memory,” said study co-author Jean K. Ho, PhD, in the press release. “It suggests that people who are being treated for hypertension may be protected from cognitive decline if they medications that cross the blood-brain barrier.”
There were a few limitations to the study, including that the study authors could not account for differences in racial and ethnic background based on the available studies and the difference in proportion between men and women in the group who took medications crossing the blood-brain barrier. Future research should focus on this area, since previous studies have shown that those with various racial/ethnic backgrounds may respond differently to different blood pressure medications, according to the study authors.
Some blood pressure-lowering meds linked to less memory decline in older adults. American Heart Association. Published June 21, 2021. Accessed June 21, 2021. https://newsroom.heart.org/news/some-blood-pressure-lowering-meds-linked-to-less-memory-decline-in-older-adults