Study Suggests Anti-Hypertensive Medication May Reduce Risk of Dementia among Veterans with Diabetes
Diabetes is associated with a 50% to 100% increased risk of dementia. Diabetes also is commonly associated with hypertension, and 60% to 80% of patients with diabetes also may suffer from hypertension. This retrospective study examined the association between hypertension and anti-hypertensive medications — and the risk of dementia in elderly Veterans with diabetes. Using VA and Medicare data, investigators identified a national cohort of 377,838 VA patients aged 65 and older who were diagnosed with diabetes from 10/96 through 12/00. Investigators assessed patient socio-demographics, comorbidities, and prevalence of hypertension (overall, 82% of Veterans with diabetes had hypertension). They also identified anti-hypertensive medications, e.g., alpha blockers, ACE (angiotensin-converting enzyme) inhibitors, ARBs (angiotensin receptor blockers), beta-blockers, CCBs (calcium channel blockers), and diuretics, which were prescribed for patients between 1/00 and 12/00. Incidence of dementia was based on VA and Medicare records from 1/01 through 12/02.
Findings showed that comorbid hypertension was associated with increased risk of dementia; however, anti-hypertensive medications, particularly ACE inhibitors and ARBs, were associated with reduced risk of dementia, even among Veterans without hypertension. The most protective effect was associated with ARB use (approximately 24% lower risk of dementia), followed by diuretics (14%), ACE inhibitors (11%), CCBs (7%), and beta blockers (4%). Factors associated with higher incidence of dementia included: increasing age (Veterans >85 had more than three times greater risk compared to Veterans age 65), as well as duration of diabetes and higher comorbidity. Also, African Americans and other non-white races were more likely to have dementia.
These findings suggest that ARBs and ACE inhibitors be considered when prescribing medication for the control of hypertension among patients with diabetes.
Johnson M, Parikh N, Kunik M, et al. Anti-hypertensive drug use and the risk of dementia in patients with diabetes mellitus. Alzheimer’s & Dementia April 20, 2012;e-pub ahead of print.
This study was funded by HSR&D (IIR 02-081). Drs. Johnson and Kunik are part of HSR&D's Houston Center for Quality of Care & Utilization Studies.