An observational study from Ireland raises the intriguing possibility that certain blood pressure lowering drugs, centrally acting ACE inhibitors, may help slow the cognitive decline that is a hallmark of people with Alzheimer’s disease and other forms of dementia.
The study, published in BMJ Open, followed the rates of cognitive decline in 3 groups of patients: dementia patients being treated with centrally acting ACE inhibitors, dementia patients being treated with non-centrally acting ACE inhibitors, and dementia patients newly treated with centrally acting ACE inhibitors.
After six months, there was a significant difference in the rate of decline between the centrally acting ACE inhibitor group and the non-centrally acting ACE inhibitor group in the rate of decline as assessed by the Quick Mild Cognitive Impairment (Qmci) score and a similar but not significant difference in the Standardised Mini-Mental State Examination (SMMSE). This same pattern has been previously observed.
A novel finding, however, was that patients newly treated with centrally acting ACE inhibitors actually had an improvement in their SMMSE scores, compared with declining scores in both groups of patients already taking ACE inhibitors.
The differences in the SMMSE achieved statistical significance, and remained significant after multivariate analysis, though the investigators acknowledged that ”the differences were small and of uncertain clinical significance.” However, they speculated that the differences could result in important clinical benefits “if sustained over years.”
The centrally acting ACE inhibitors in the study were perindopril, ramipril, trandolapril, captopril, fosinopril, lisinopril, prinivil and monopril.
Labels: ace-inhibitors, qmci, smmse