Some heart drugs may slow mental decline with age

NEW YORK (Reuters Health) - Older people who take certain blood pressure-lowering drugs may also be protecting themselves from declines in memory and other brain function, research suggests.

The drugs that researchers believe are protective are part of a class known as ACE inhibitors -- specifically those types that enter the brain and may help curb inflammation that might contribute to dementia.

The study found a link between taking these “centrally acting” ACE inhibitors and lower rates of mental decline as measured by the Modified Mini-Mental State Exam, a test that evaluates memory, language, and other cognitive functions.

For each year that subjects were exposed to centrally acting ACE inhibitors that enter the brain, the decline in test results was 50 percent lower than the decline in people taking other kinds of high blood pressure pills.

While the actual difference was small, “after a few years of being on the drug, I’d say it’s a relevant difference,” Dr. Kaycee Sink of Wake Forest University School of Medicine in Winston-Salem, North Carolina told Reuters Health.

Centrally acting ACE inhibitors include captopril (Capoten), fosinopril (Monopril), lisinopril (Prinivil or Zestril), perindopril (Aceon), ramipril (Altace) and trandolapril (Mavik).

Sink decided to investigate the effect of centrally acting ACE inhibitors on dementia risk after her Wake Forest colleagues found the drugs protected rats from brain injury due to radiation. She presented her findings May 5 at the American Geriatrics Society’s annual meeting in Seattle.

She and her colleagues looked at a subgroup of 1,074 men and women participating in a study of cardiovascular health who were taking drugs to treat hypertension and were dementia-free when the study began.

While the centrally acting ACE inhibitors did slow cognitive decline, as Sink had hypothesized, the non-centrally active ACE inhibitors that don’t reach the brain actually boosted the risk of developing dementia by 20 percent, although the effect didn’t reach statistical significance.

The centrally acting ACE inhibitors could be protecting the brain by reducing inflammation, which has been implicated in Alzheimer’s disease, or they might be increasing blood flow to the brain, Sink said.

If she had to take an ACE inhibitor, Sink said, she’d ask to be prescribed a centrally acting one. “There doesn’t seem to be any downside, and they may be benefiting you.”

However, a clinical trial in which people taking centrally acting ACE inhibitors and people taking different blood pressure drugs are followed to determine who develops dementia will be necessary to confirm the results, she added.