Associations of angiotensin targeting antihypertensive drugs with mortality and hospitalization in primary care patients with dementia.
We investigated whether angiotensin II receptor blockers and angiotensin converting enzyme inhibitors were associated with risk of mortality or inpatient hospitalization for patients with dementia compared to other antihypertensive medications. We extracted a clinical cohort of 6,290 patients with dementia from the United Kingdom General Practice Research Database, prescribed antihypertensive medication at diagnosis of dementia with around 10 years follow-up. Using survival analysis we estimated associations of exposure to antihypertensive medication with subsequent hospitalization and mortality risk, stratified by dementia type (Alzheimer's disease, vascular and other dementias). Angiotensin converting enzyme inhibitors (but not angiotensin II receptor blockers) were associated with an increased risk of mortality in patients with Alzheimer's disease (adjusted hazard ratio: 1.19; 95% CI 1.07, 1.33, p = 0.002), but no convincing evidence of increased hospitalization. Angiotensin II receptor blockers were inversely associated with hospitalization for any form of dementia, but after adjustment for covariates, these associations became consistent with chance. Further evidence is required to either support or refute the observation that exposure to angiotensin converting enzyme inhibitors in patients with dementia is associated with increased mortality.
Faculty of Medicine and Dentistry, School of Clinical Sciences, Dementia Research Group, University of Bristol, John James Laboratories, Frenchay Hospital, Bristol, UK. Patrick.Kehoe@bristol.ac.uk
Patrick Gavin
PG
Kehoe
Neil Martin
NM
Davies
Richard Michael
RM
Martin
Yoav
Y
Ben-Shlomo
D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D003704:Dementia / Q000188:drug therapy / Q000401:mortality*; D016503:Drug Delivery Systems / Q000379:methods* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011320:Primary Health Care / Q000379:methods* / Q000639:trends
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents