title: Angiotension receptor blockers reduce the risk of dementia.
abstract: OBJECTIVE
  Recent studies implied that angiotension receptor blockers (ARBs) not only have an antihypertensive effect but also have beneficial effects on dementia. The purpose of this study was to investigate the effects of ARBs on dementia and the subtypes.
  
  
  METHODS
  We conducted a population-based cohort study with data from the Taiwan National Health Insurance Research Database. A total of 24 531 matching pairs (1 : 1) of ARB-exposed and non-ARB-exposed patients were included. Each patient was individually tracked from 1997 to 2009 to identify incident cases of dementia (onset in 1999 or later). Cox proportional hazard regressions were employed to calculate the hazard ratios and 95% confidence intervals (CIs) for the association between ARBs and dementia, Alzheimer's disease and vascular dementia, conditional for matching pairs.
  
  
  RESULTS
  There were 1322 cases (5.4%) of dementia in the ARB cohort and 2181 cases (8.9%) in the non-ARB cohort identified during the 11-year follow-up period. The multivariate-adjusted hazard ratios for dementia, Alzheimer's disease and vascular dementia were 0.54 (95% CI 0.51-0.59), 0.53 (95% CI 0.43-0.64) and 0.63 (95% CI 0.54-0.73) for patients with ARB treatments, respectively. In terms of cumulative dosage, patients with more than 1460 defined daily dose of ARBs had less risk than those patients with less than 1460 defined daily dose (hazard ratio 0.37 vs. 0.61; P < 0.05).
  
  
  CONCLUSIONS
  These results suggest that ARB may be associated with a reduced risk of dementia in high vascular-risk individuals. Patients exposed to ARBs for higher cumulative doses experienced more protection from dementia and the subtypes.
authors.affiliation: aInstitute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health bDepartment of Psychiatry, Cathay General Hospital cSchool of Medicine, Fu Jen Catholic University, Taipei dDepartment of Public Health, China Medical University, Taichung eDepartment of Internal Medicine, Taipei City Hospital, Zhongxing Branch fSchool of Medicine, Taipei Medical University, Taipei gDepartment of Public Health, National Cheng Kung University College of Medicine, Tainan hDepartment of Public Health, National Taiwan University College of Public Health iDepartment of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Chiu
authors.forename: Wen-Chao
authors.initials: WC
authors.lastname: Ho
authors.forename: Meng-Hung
authors.initials: MH
authors.lastname: Lin
authors.forename: Hsiu-Hao
authors.initials: HH
authors.lastname: Lee
authors.forename: Yu-Chi
authors.initials: YC
authors.lastname: Yeh
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016208:Databases, Factual; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013624:Taiwan
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents