Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in context
Summary: 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 inc...
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Elsevier
2024-11-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352396424004146 |
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| author | Sori Kim Lundin Xinyue Hu Jingna Feng Karl Kristian Lundin Lu Li Yong Chen Paul Ernest Schulz Cui Tao |
| author_facet | Sori Kim Lundin Xinyue Hu Jingna Feng Karl Kristian Lundin Lu Li Yong Chen Paul Ernest Schulz Cui Tao |
| author_sort | Sori Kim Lundin |
| collection | DOAJ |
| description | Summary: 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). |
| format | Article |
| id | doaj-art-d9c49ebaa02640ff9cb899a0192a868d |
| institution | Kabale University |
| issn | 2352-3964 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
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| series | EBioMedicine |
| spelling | doaj-art-d9c49ebaa02640ff9cb899a0192a868d2024-11-14T04:32:18ZengElsevierEBioMedicine2352-39642024-11-01109105378Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in contextSori Kim Lundin0Xinyue Hu1Jingna Feng2Karl Kristian Lundin3Lu Li4Yong Chen5Paul Ernest Schulz6Cui Tao7Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Center for Biomedical Semantics and Data Intelligence, University of Texas Health Science Center at Houston, Houston, TX 77030, USADepartment of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL 32224, USADepartment of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL 32224, USADepartments of Medicine and Pediatrics, Baylor College of Medicine, Houston, TX 77030, USADepartment of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USADepartment of Biostatistics, Epidemiology and Informatics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USADepartment of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; Neurocognitive Disorders Center, The University of Texas Health Science Center at Houston Neurosciences, Houston, TX 77054, USADepartment of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL 32224, USA; Corresponding author. Department of Artificial Intelligence and Informatics, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.Summary: 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).http://www.sciencedirect.com/science/article/pii/S2352396424004146ADRDAntihypertensive medicationsHypertensionBlood–brain barrierDementia |
| spellingShingle | Sori Kim Lundin Xinyue Hu Jingna Feng Karl Kristian Lundin Lu Li Yong Chen Paul Ernest Schulz Cui Tao Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in context EBioMedicine ADRD Antihypertensive medications Hypertension Blood–brain barrier Dementia |
| title | Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in context |
| title_full | Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in context |
| title_fullStr | Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in context |
| title_full_unstemmed | Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in context |
| title_short | Association between risk of Alzheimer’s disease and related dementias and angiotensin receptor Ⅱ blockers treatment for individuals with hypertension in high-volume claims dataResearch in context |
| title_sort | association between risk of alzheimer s disease and related dementias and angiotensin receptor ii blockers treatment for individuals with hypertension in high volume claims dataresearch in context |
| topic | ADRD Antihypertensive medications Hypertension Blood–brain barrier Dementia |
| url | http://www.sciencedirect.com/science/article/pii/S2352396424004146 |
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