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Antihypertensive Treatment is associated with MRI-Derived Markers of Neurodegeneration and Impaired Cognition: A Propensity-Weighted Cohort Study.
- Source :
-
Journal of Alzheimer's disease : JAD [J Alzheimers Dis] 2017; Vol. 59 (3), pp. 1113-1122. - Publication Year :
- 2017
-
Abstract
- Background: Hypertension is an important risk factor for Alzheimer's disease (AD) and cerebral small vessel disease. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are common anti-hypertensive treatments, but have differential effects on cortical amyloid.<br />Objective: The objective of this study was to evaluate associations between anti-hypertensive treatment, brain volume, and cognition, using a propensity-weighted analysis to account for confounding by indication.<br />Methods: We identified a cohort of normal elderly adults and individuals with mild cognitive impairment (MCI) or AD (N = 886; mean age = 75.0) from the Alzheimer's Disease Neuroimaging Initiative. Primary outcomes were brain parenchymal fraction, total hippocampal volume, and white matter hyperintensity (WMH) volume. Secondary outcomes were standardized scores on neuropsychological tests. Propensity-weighted adjusted multivariate linear regression was used to estimate associations between anti-hypertensive treatment class and MRI volumes and cognition.<br />Results: Individuals treated with ARBs showed larger hippocampal volumes (R2 = 0.83, p = 0.05) and brain parenchymal fraction (R2 = 0.83, p = 0.01) than those treated with ACEIs. When stratified by diagnosis, this effect remained only in normal elderly adults and MCI patients, and a significant association between ARBs and lower WMH volume (R2 = 0.83, p = 0.03) emerged for AD patients only. ARBs were also associated with significantly better performance on tests of episodic and verbal memory, language, and executive function (all p < 0.05).<br />Conclusions: Findings are consistent with evidence for a neuroprotective effect of treatment with ARBs for brain structure and cognition. This study has potential implications for the treatment of hypertension, particularly in elderly adults at risk of cognitive decline and AD.
- Subjects :
- Aged
Aged, 80 and over
Angiotensin Receptor Antagonists therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Cohort Studies
Female
Humans
Hypertension diagnostic imaging
Linear Models
Magnetic Resonance Imaging
Male
Neuropsychological Tests
Treatment Outcome
Alzheimer Disease diagnostic imaging
Alzheimer Disease prevention & control
Antihypertensive Agents therapeutic use
Brain diagnostic imaging
Brain drug effects
Brain pathology
Cognitive Dysfunction diagnostic imaging
Cognitive Dysfunction prevention & control
Hypertension drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1875-8908
- Volume :
- 59
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of Alzheimer's disease : JAD
- Publication Type :
- Academic Journal
- Accession number :
- 28731439
- Full Text :
- https://doi.org/10.3233/JAD-170238