{"title":"Risk of Dementia With Renin-Angiotensin System Inhibitors Versus Calcium Channel Blockers in Hypertensive Adults: A Nationwide Multicenter Study.","authors":"Yinfang Sun, Zhixin Guo, Jinming Zhang, Mingzhen Pang, Ruixuan Chen, Caoxiang She, Shiyu Zhou, Hao Wang, Xian Shao, Sheng Nie","doi":"10.1007/s40266-026-01337-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate whether renin-angiotensin system inhibitors (RASIs) reduce dementia risk independently of blood pressure control compared with calcium channel blockers (CCBs) in antihypertensive-naïve adults with hypertension.</p><p><strong>Methods: </strong>This multicenter, new-user active comparator study included antihypertensive-naïve adults initiating RASIs or CCBs across 28 hospitals. Participants were matched 1:1 on baseline characteristics using propensity score matching (PSM). The primary outcome was incident all-cause dementia; secondary outcomes were Alzheimer's disease and vascular dementia. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.</p><p><strong>Results: </strong>Of 164,918 eligible patients (median age 65 years [interquartile range 55-74]; 51.2% male), 54,042 PSM pairs initiating RASIs versus CCBs were included. During a median follow-up of 516 days, 344 incident dementia cases occurred. The incidence rate of all-cause dementia was lower among RASI initiators than CCB initiators (1.26 vs 1.89 per 1000 person-years). Initiation of RASIs was associated with a significantly lower risk of all-cause dementia (HR 0.68, 95% CI 0.55-0.84) and Alzheimer's disease (HR 0.59, 95% CI 0.43-0.81), but not vascular dementia (HR 0.74, 95% CI 0.50-1.11), compared with CCBs. There was no significant difference in dementia risk between initiators of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs).</p><p><strong>Conclusions: </strong>In adults with hypertension, initiation of RASIs was associated with a significantly lower risk of dementia compared with CCBs. No significant difference was observed between ACEIs and ARBs. Further validation is warranted.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Drugs & Aging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s40266-026-01337-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: The aim of this study was to evaluate whether renin-angiotensin system inhibitors (RASIs) reduce dementia risk independently of blood pressure control compared with calcium channel blockers (CCBs) in antihypertensive-naïve adults with hypertension.
Methods: This multicenter, new-user active comparator study included antihypertensive-naïve adults initiating RASIs or CCBs across 28 hospitals. Participants were matched 1:1 on baseline characteristics using propensity score matching (PSM). The primary outcome was incident all-cause dementia; secondary outcomes were Alzheimer's disease and vascular dementia. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.
Results: Of 164,918 eligible patients (median age 65 years [interquartile range 55-74]; 51.2% male), 54,042 PSM pairs initiating RASIs versus CCBs were included. During a median follow-up of 516 days, 344 incident dementia cases occurred. The incidence rate of all-cause dementia was lower among RASI initiators than CCB initiators (1.26 vs 1.89 per 1000 person-years). Initiation of RASIs was associated with a significantly lower risk of all-cause dementia (HR 0.68, 95% CI 0.55-0.84) and Alzheimer's disease (HR 0.59, 95% CI 0.43-0.81), but not vascular dementia (HR 0.74, 95% CI 0.50-1.11), compared with CCBs. There was no significant difference in dementia risk between initiators of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs).
Conclusions: In adults with hypertension, initiation of RASIs was associated with a significantly lower risk of dementia compared with CCBs. No significant difference was observed between ACEIs and ARBs. Further validation is warranted.
目的：本研究的目的是评估在antihypertensive-naïve成人高血压患者中，与钙通道阻滞剂（CCBs）相比，肾素-血管紧张素系统抑制剂（RASIs）是否能独立于血压控制降低痴呆风险。方法：这项多中心、新用户主动比较研究包括来自28家医院的antihypertensive-naïve成人启动RASIs或CCBs。使用倾向评分匹配（PSM）对参与者的基线特征进行1:1匹配。主要结局是偶发性全因痴呆；次要结局是阿尔茨海默病和血管性痴呆。采用Cox比例风险回归估计风险比（hr）和95%置信区间（CIs）。结果：在164,918例符合条件的患者（中位年龄65岁[四分位数范围55-74]；51.2%为男性）中，包括54,042对启动RASIs与CCBs的PSM对。在平均516天的随访期间，发生了344例痴呆。RASI启动者的全因痴呆发病率低于CCB启动者（1.26 vs 1.89 / 1000人-年）。与CCBs相比，RASIs的开始与全因痴呆（HR 0.68, 95% CI 0.55-0.84）和阿尔茨海默病（HR 0.59, 95% CI 0.43-0.81）的风险显著降低相关，但与血管性痴呆（HR 0.74, 95% CI 0.50-1.11）无关。血管紧张素转换酶抑制剂（ACEIs）和血管紧张素II受体阻滞剂（ARBs）的启动者在痴呆风险方面没有显著差异。结论：在患有高血压的成人中，与CCBs相比，RASIs的开始与痴呆的风险显著降低相关。acei与arb之间无显著差异。进一步的验证是必要的。
期刊介绍：
Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly.
The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.
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