Cognitive decline may be slower when antihypertensive drugs cross the blood-brain barrier

According to the results of a systematic review and a meta-analysis, patients with hypertension who took the blood-brain barrier (BBB) ​​crossed renin-angiotensin drugs despite the increased vascular burden compared to patients who took non-penetrating drugs , less memory loss. These results were published in Hypertension.

Publication databases were searched for studies of hypertension, Alzheimer’s disease, dementia, and cognition treated with BBB-crossing or non-penetrative drugs. A total of 14 studies (prospective: n = 10; retrospective: n = 3; randomized study: n = 1) with 12,849 patients were included.

At the start of the study, participants who took drugs that crossed the BBB and non-penetrating drugs did not differ in terms of cognitive measures of verbal learning memory (g, 0.0007; P = 0.98) or verbal memory (g, -0.04; P = 0.60), processing speed (g, -0.16; P = .48), executive function (g, 0.04; P = .45), attention (g, 0.04; P = .40 ), mental status (g, -0.05; P = .13) and language (g, 0.02; P =, 12).

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After a 3-year follow-up, verbal recall was in the BBB crossover cohort (effect size 0.07; 95% CI 0.01-0.12; P = 0.03; I2.0%) and the users of non-penetrating drugs had significantly higher significantly superior attention scores (effect size, -0.17; 95% CI, -0.23 to -0.10; P = 0.02; I2, 0%).

At follow-up, no group differences were found for mental status (g, 0.02; P = 0.88), executive function (g, -0.03; P = 0.80), language (g, -0 , 01; P = 0.41) observed. or verbal learning memory (g, 0.05; P = 0.19).

These results may have been skewed by underlying cohort differences such as significant differences in gender (P <.02) and education (P = .02), as well as variations in ethnic diversity in different studies.

These data showed that the antihypertensive drugs that many patients took decades before the onset of the cognitive decline associated with Alzheimer’s disease can be compromised with long-term use. BBB-crossing renin-angiotensin drugs were associated with less memory loss but poorer alertness.

These seemingly conflicting results can be explained by the increased vascular stress associated with drugs that cause BBB crossover.


Ho JK, Moriarty F, Manly JJ et al. Blood-Brain Barrier Crossing Renin Angiotensin Drugs and Cognition in the Elderly: A Meta-Analysis. Hypertension. Published online June 21, 2021. 2021; hypertensionaha12117049. doi: 10.1161 / hypertensionaha.121.17049

This article originally appeared on The Cardiology Advisor

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