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Fluke or Trend: ACE Inhibitors vs Alzheimer's Disease

Posted Aug 01 2013 3:00am
ACE inhibitors & ARBs are two major classes of blood pressure lowering medications, related to each other like cousins.  The former runs a slight risk of causing a dry ticklish cough.  Otherwise, one or the other are often used to protect one's kidneys & heart, in addition to lowering blood pressure.  Just under a year ago, another study was published linking the use of ARBs to lower rates of brain pathology consistent with that most common cause of dementia.  But as I noted in my post, there have been several studies suggesting that ARBs are beneficial when it comes to dementia.

Interestingly enough, a longitudinal prospective population-based study was published 4 years ago in JAMA Internal Medicine looking at the effect of ACE inhibitors with regards to Alzheimer's disease.  Taken as a whole, there was no link.  But if you looked at just the centrally acting ACE inhibitors, their use was linked to a lower rate of cognitive decline, more so than when compared to noncentrally acting ACE inhibitors.  Which brings me to an observational case-control study published last week/month in BMJ Open in which centrally acting ACE inhibitors were linked to improvement in cognition & reduction in cognitive decline.  The authors made their conclusion after following for six months 361 patients w/Alzheimer's disease, of whom 85 received a centrally acting ACE inhibitor while 276 did not.

So if you need to take blood pressure medication(s), one of which is an ACE inhibitor, I'm sure you're curious which ones cross the blood-brain barrier: captopril, fosinopril, lisinopril, perindopril, ramipril & trandolapril. On the other hand, benazepril, enalapril, moexipril & quinapril do not.  The good news for you & me is that captopril & lisinopril are available for $4/mo at WalMart and its competitors .

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