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Antihypertensive drug classes and risk of incident dementia: a multinational population-based cohort study

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dc.contributor.authorCheung, E.C.L.
dc.contributor.authorAdesuyan, M.
dc.contributor.authorSzilcz, M.
dc.contributor.authorKalisch Ellett, L.M.
dc.contributor.authorShah, S.
dc.contributor.authorJani, Y.H.
dc.contributor.authorHägg, S.
dc.contributor.authorPratt, N.
dc.contributor.authorLau, K.K.
dc.contributor.authorLuo, H.
dc.contributor.authorWan, E.Y.F.
dc.contributor.authorChan, E.W.Y.
dc.contributor.authorWong, I.C.K.
dc.contributor.authorYuen, J.K.
dc.contributor.authorYiu, K.H.
dc.contributor.authorHoward, R.
dc.contributor.authorBrauer, R.
dc.contributor.authorChui, C.S.L.
dc.date.issued2025
dc.descriptionData source: supplementary data, https://doi.org/10.1093/ageing/afaf121
dc.description.abstract<h4>Background</h4>Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) are first-line antihypertensive drugs for many patients, and influencing angiotensin systems may play a role in dementia risk. This study aimed to investigate whether exposure to different antihypertensive drug classes compared with ACEI affects the risk of dementia and pathological dementia subtypes in a large multinational database study.<h4>Methods</h4>This was a multinational population-based cohort study using electronic health databases in Hong Kong, the UK, Sweden and Australia. A common protocol was used to harmonise the study design. An active comparator, a new user design, was applied to compare the risk of all-cause dementia between different antihypertensive drug classes, with secondary outcomes of Alzheimer's disease (AD) and vascular dementia (VaD). Adjusted Cox proportional hazards models with inverse probability of treatment weighting were used to generate results in each study site and were pooled in meta-analysis.<h4>Results</h4>One million nine hundred twenty-five thousand, five hundred sixty-three individuals were included across the four databases with a median follow-up ranging from 5.6 to 8.4 years. Compared to ACEI, initiation with ARB was associated with a reduced risk of incident all-cause dementia [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.89-0.94] and VaD (HR 0.87, 95% CI 0.78-0.96) but not AD.<h4>Conclusions</h4>This is the largest multinational cohort study conducted to date investigating different classes of antihypertensive drugs and the risk of incident dementia. When initiating antihypertensives, physicians and patients should consider the reduced risk of all-cause dementia and VaD with ARB compared with ACEI in their risk-benefit assessment.
dc.identifier.citationAge and Ageing, 2025; 54(5)
dc.identifier.doi10.1093/ageing/afaf121
dc.identifier.issn0002-0729
dc.identifier.issn1468-2834
dc.identifier.orcidKalisch Ellett, L.M. [0000-0001-5063-6128]
dc.identifier.orcidPratt, N. [0000-0001-8730-8910]
dc.identifier.urihttps://hdl.handle.net/11541.2/44113
dc.language.isoen
dc.publisherOXFORD UNIV PRESS
dc.relation.fundingHong Kong Research Grants Council General Research Fund 17113720
dc.relation.grant17113720
dc.rightsCopyright 2025 The Authors. (https://creativecommons.org/licenses/by-nc/4.0/) Access Condition Notes: This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.source.urihttps://doi.org/10.1093/ageing/afaf121
dc.subjectHumans
dc.subjectDementia
dc.subjectHypertension
dc.subjectAntihypertensive Agents
dc.subjectAngiotensin-Converting Enzyme Inhibitors
dc.subjectIncidence
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectDatabases, Factual
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectMiddle Aged
dc.subjectHong Kong
dc.subjectAustralia
dc.subjectFemale
dc.subjectMale
dc.subjectAngiotensin Receptor Antagonists
dc.titleAntihypertensive drug classes and risk of incident dementia: a multinational population-based cohort study
dc.typeJournal article
pubs.publication-statusPublished
ror.fileinfo12305599440001831 13305599430001831 afaf121
ror.mmsid9916975535001831

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