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Do angiotensin receptor blockers prevent Alzheimer's disease?

Hajjar, Ihaba; Rodgers, Kathleenb

Current Opinion in Cardiology: July 2013 - Volume 28 - Issue 4 - p 417–425
doi: 10.1097/HCO.0b013e3283620745
HYPERTENSION: Edited by William J. Elliott

Purpose of review: The recent advances in our understanding of Alzheimer's disease pathophysiology and the renin angiotensin system pathways suggest that angiotensin receptor blockers (ARBs) are ideal drugs to explore for Alzheimer's disease therapy.

Recent findings: New evidence suggests that the brain renin angiotensin system has two opposing pathways: a damaging pathway and a neuro-protective pathway. Both pathways are involved in the amyloid hypothesis (Aβ cascades) and vascular mechanisms of Alzheimer's disease. Studies in animal models suggest that ARBs have cognitive protective effects that are related to their ability to decrease production and oligomerization and increase degradation of Aβ and their vascular effects (improve blood–brain barrier, restore endothelial function, decrease inflammation, and increase cerebral blood flow). Human observational studies have further suggested that ARB use is associated with decreased risk of Alzheimer's disease and protection against future cognitive decline. Our work has suggested that ARB use is associated with decreased amyloid deposition in the brain in Alzheimer's disease and can provide cognitive protection in those with mild cognitive impairment, a prodromal state for Alzheimer's disease, and dementia.

Summary: To date, no robust clinical trial of ARBs in Alzheimer's disease has been performed. All things being equal, it is reasonable to consider ARBs in those with cognitive risks.

aDivision of Geriatric, Hospital, Palliative and General Internal Medicine

bClinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California, California, USA

Correspondence to Ihab Hajjar, MD, MS, 2020 Zonal Avenue, Room 320, Los Angeles, CA 90033, USA. Tel: +1 323 2267554; e-mail: ihajjar@usc.edu

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins