title: Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure.
abstract: OBJECTIVE
  Cognitive dysfunction is a prevalent condition among patients with heart failure, and is independently associated with disability and mortality. Angiotensin-converting enzyme (ACE)-inhibitors might increase cerebral blood flow in subjects with heart failure. Our aim was to assess whether starting treatment with ACE-inhibitors might improve cognition in patients with heart failure.
  
  
  RESULTS
  Analyses involved 12 081 subjects, 1220 of whom had a verified diagnosis of heart failure, enrolled in a multi-centre pharmaco-epidemiology survey. None of these participants received ACE-inhibitors before hospitalization. Among participants with heart failure, cognitive performance improved in 30% of 446 participants who started ACE-inhibitors, but only in 22% of remaining patients (P=0.001). Among participants without heart failure, cognition improved in 19% of those receiving ACE-inhibitors, and in 18% of untreated patients (P=0.765). Use of ACE-inhibitors among patients with heart failure was associated with improving cognition (odds ratio=1.57; 95% CI 1.18-2.08) also in the multivariable regression modelling, independently of baseline or discharge blood pressure levels. The probability of improving cognitive performance was higher for dosages above the median values, as compared with lower doses (odds ratios=1.90 and 1.42; P for trend=0.001), and increased with duration of treatment (odds ratios for the lower, middle, and upper tertiles=1.25, 1.34, and 1.59; P for trend=0.007).
  
  
  CONCLUSIONS
  Treatment with ACE-inhibitors might selectively improve cognitive performance in patients with heart failure. However, up-titration of these agents might be required to yield the greatest benefit.
authors.affiliation: Catholic University, Department of Gerontology, Geriatrics, and Physiatrics, L.go F. Vito, I-00168 Rome, Italy. giuseppe_zuccala@rm.unicatt.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zuccalà
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.forename: Emanuele
authors.initials: E
authors.lastname: Marzetti
authors.forename: Maria R Lo
authors.initials: MR
authors.lastname: Monaco
authors.forename: Matteo
authors.initials: M
authors.lastname: Cesari
authors.forename: Alberto
authors.initials: A
authors.lastname: Cocchi
authors.forename: Pierugo
authors.initials: P
authors.lastname: Carbonin
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007902:Length of Stay; D008297:Male
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors