Renin-angiotensin system blockade use and risks of cognitive decline and dementia: A meta-analysis. (15th June 2016)

• Record Type: Journal Article
• Authors: Zhuang, Shan; Wang, Hai-feng; Li, Jun; Wang, Hong-yan; Wang, Xin; Xing, Cheng-ming
• Is Part Of: Neuroscience letters. Volume 624(2016)
• Page Start: 53
• Page End: 61
• Publication Date: 2016-06-15
• Subjects: Dementia -- Cognitive decline -- Renin-angiotensin system blockade -- Angiotensin-converting enzyme inhibitors -- Angiotensin receptor blockers -- Meta-analysis; Neurology -- Periodicals; Neurology -- Periodicals; Research -- Periodicals; Neurologie -- Périodiques; Neuroanatomie -- Périodiques; Neuropharmacologie -- Périodiques; Neurophysiologie -- Périodiques; Neurology; Periodicals; Electronic journals; 617.48
• DOI: 10.1016/j.neulet.2016.05.003
• Languages: English
• ISSNs: 0304-3940

Abstract

Highlights: We found that RASB drugs, both ACEIs and ARBs, could decrease the risk of dementia. However, ARBs use is likely to be analogous to ACEIs on the incidence of dementia. CACEIs may decrease the risk of dementia; however, PACEIs may be opposite. RASB was shown to reduce the risk of dementia in observational studies, not in RCTs. CACEIs use, rather than ARBs use, may play a protective role in cognitive decline. Abstract: Objective: To evaluate the effects of renin-angiotensin system blockade (RASB) and its classes on the incidences of cognitive decline and dementia. Methods: PubMed, the EMBASE database and Cochrane Library were searched through October 2015 for eligible studies. We included ten studies that analyzed the effects of RASB treatment on the incidence of cognitive decline or dementia. Results: We found that the use of RASB was associated with a reduced risk of dementia (RR, 0.84; 95% CI, 0.76–0.92), when randomized trials and observational trials were considered together. Meanwhile, regardless of the drug class, both the angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were shown to effectively decrease the incidence rate of dementia (RR, 0.89; 95% CI, 0.82–0.96; RR, 0.79; 95% CI, 0.64–0.94, respectively). Furthermore, indirect comparison between ACEIs and ARBs revealed no correlation in incident dementia (RR, 0.89, 95% CI 0.72–1.09, p = 0.26). However, centrally acting ACEIs (CACEIs) protected against the occurrence of dementia (RR, 0.94; 95% CI, 0.91–0.97); on the contrary, peripheral ACEIs (PACEIs) increased the risk of dementia (RR, 1.20; 95% CI, 1.00–1.43). In an analysis of cognitive decline, CACEIs use was shown to decrease the risk of cognitive decline (RR, 0.92; 95% CI, 0.83–1.00); however, ARBs use had no significant association with the risk of cognitive decline (RR, 0.98; 95% CI, 0.90–1.05). Conclusions: RASB antihypertensive drugs may be potential treatments for reducing the incidence of dementia, but ARBs use is likely to be analogous to ACEIs. The association of dementia with CACEIs and PACEIs may be opposite, with CACEIs being effective. Meanwhile, the benefit differing according to drug classes for cognitive decline, CACEIs use, rather than ARBs use, is likely to play protective role in cognitive decline.