Association between risk of Alzheimer's disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims data.

IF 9.7 1区医学 Q1 MEDICINE, RESEARCH & EXPERIMENTAL EBioMedicine Pub Date : 2024-11-01 Epub Date: 2024-10-03 DOI:10.1016/j.ebiom.2024.105378

Sori Kim Lundin, Xinyue Hu, Jingna Feng, Karl Kristian Lundin, Lu Li, Yong Chen, Paul Ernest Schulz, Cui Tao

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引用次数: 0

Abstract

Background: Findings regarding the protective effect of Angiotensin II receptor blockers (ARBs) against Alzheimer's disease and related dementias (AD/ADRD) and cognitive decline have been inconclusive.

Methods: Individuals with hypertension who do not have any prior ADRD diagnosis were included in this retrospective cohort study from Optum's de-identified Clinformatics® Data Mart. We identified antihypertensive medication (AHM) drug classes and subclassified ARBs by blood-brain barrier (BBB) permeability. We compared baseline characteristics and used the Kaplan-Meier (KM) survival curve and adjusted Cox proportional hazards (PH) model for survival analyses.

Findings: From 6,390,826 individuals with hypertension, there were 1,839,176 ARB users, 3,366,841 non-ARB AHM users, and 1,184,809 AHM non-users. The unadjusted KM curve showed that ARB users had lower cumulative hazard than other AHM users or AHM non-users (P < 0.0001). In Cox PH analysis, ARB users showed a 20% lower adjusted hazard of developing ADRD compared to angiotensin-converting enzyme inhibitor (ACEI) users and a 29% and 18% reduced hazard when compared to non-ARB/ACEI AHM users and AHM non-users (all P < 0.0001). Consumption of BBB-crossing ARBs was linked to a lower hazard of ADRD development than non-BBB-crossing ARBs, undetermined ARBs, and non-consumption of AHMs by 11%, 25%, and 31% (all P < 0.0001).

Interpretation: This study suggests that ARBs are superior to ACEIs, non-ARB/ACEI AHMs, or non-use of AHMs in reducing the hazard of ADRD among patients with hypertension. Also, BBB-permeability in ARBs was associated with lower ADRD incidence. There is no cure for AD, ADRD, or vascular dementia; hence, these findings are significant in preventing those disorders in an inexpensive, convenient, and safe way. Limitations in claims data should be considered when interpreting our findings.

Funding: This research was supported by the National Institute on Aging grants (R01AG084236, R01AG083039, RF1AG072799, R56AG074604).

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大量索赔数据中阿尔茨海默病及相关痴呆症风险与高血压患者血管紧张素受体Ⅱ阻滞剂治疗之间的关系。

背景：有关血管紧张素 II 受体阻滞剂 (ARB) 对阿尔茨海默病及相关痴呆症 (AD/ADRD) 和认知能力下降的保护作用的研究结果尚无定论：这项回顾性队列研究从 Optum 的去标识化 Clinformatics® 数据集市中纳入了既往未确诊 ADRD 的高血压患者。我们确定了抗高血压药物 (AHM) 类别，并根据血脑屏障 (BBB) 渗透性对 ARB 进行了亚分类。我们比较了基线特征，并使用卡普兰-梅耶（KM）生存曲线和调整后的考克斯比例危险（PH）模型进行生存分析：在6,390,826名高血压患者中，有1,839,176名ARB使用者，3,366,841名非ARB AHM使用者，1,184,809名AHM非使用者。未经调整的 KM 曲线显示，ARB 使用者的累积危险度低于其他 AHM 使用者或非 AHM 使用者（P 解释：ARB 是一种抗心律失常药物：本研究表明，在降低高血压患者的 ADRD 风险方面，ARB 优于 ACEIs、非 ARB/ACEI AHMs 或不使用 AHMs。此外，ARB 的 BBB 渗透性也与 ADRD 发生率较低有关。注意力缺失症、注意力缺失性痴呆症或血管性痴呆症是无法治愈的；因此，这些发现对于以廉价、方便和安全的方式预防这些疾病具有重要意义。在解释我们的研究结果时，应考虑索赔数据的局限性：本研究得到了美国国家老龄化研究所（National Institute on Aging）的资助（R01AG084236、R01AG083039、RF1AG072799、R56AG074604）。

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来源期刊

EBioMedicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology

CiteScore

17.70

自引率

0.90%

发文量

579

审稿时长

5 weeks

期刊介绍： eBioMedicine is a comprehensive biomedical research journal that covers a wide range of studies that are relevant to human health. Our focus is on original research that explores the fundamental factors influencing human health and disease, including the discovery of new therapeutic targets and treatments, the identification of biomarkers and diagnostic tools, and the investigation and modification of disease pathways and mechanisms. We welcome studies from any biomedical discipline that contribute to our understanding of disease and aim to improve human health.