July 22, 2009
ACE Inhibitor Blood Pressure Drugs Cut Risk Of Dementia

Not all blood pressure drugs are equal in protection provided against brain function decline with age. The angiotensin-converting enzyme (ACE) inhibitors are better for the brain than other blood pressure reducing drugs. But not all ACE inhibitors are equal either. The centrally acting ACE inhibitors provide the benefit.

WINSTON-SALEM, N.C. – A particular class of medication used to treat high blood pressure could protect older adults against memory decline and other impairments in cognitive function, according to a newly published study from Wake Forest University School of Medicine.

Research suggests that some of the drugs classified as angiotensin-converting enzyme (ACE) inhibitors, specifically those types of ACE inhibitors that affect the brain by crossing the blood-brain barrier, may reduce inflammation that could contribute to the development of Alzheimer's disease, a major cause of dementia.

The study appears in the current issue of Archives of Internal Medicine.

"High blood pressure is an important risk factor for Alzheimer's disease and vascular dementia," said Kaycee Sink, M.D., M.A.S., lead author of the study, geriatrician and an assistant professor of internal medicine – gerontology. "Our study found that all blood pressure medications may not be equal when it comes to reducing the risk of dementia in patients with hypertension."

Inflammation as an agent of accelerated aging is a recurring theme in a lot of research on aging mechanisms. Dietary and drug factors that reduce inflammation tend to slow aging and lower disease risks.

ACE inhibitors that can cross the blood-brain barrier get into the brain and dampen inflammation.

The study found an association between taking centrally-active ACE inhibitors and lower rates of mental decline as measured by the Modified Mini-Mental State Exam, a test that evaluates memory, language, abstract reasoning and other cognitive functions. The research showed that participants who were exposed to ACE inhibitors that cross the blood-brain barrier saw an average 65 percent less cognitive decline per year of exposure compared to participants taking other blood pressure medications.

What I would like to know: For people who do not have high blood pressure (knock on wood) which drugs or dietary elements will best lower brain inflammation? Anyone have insights on this?

Non-centrally active ACE inhibitors definitely do not help.

Researchers also found that non-centrally active ACE inhibitors were associated with an increased risk of dementia and the people taking them were more likely to develop difficulty performing daily activities. Specifically, participants who, for three years, took ACE inhibitors that do not cross the blood-brain barrier were at a 73 percent greater risk of developing dementia than were the individuals taking other anti-hypertensive drugs.

Okay, those of you with high blood pressure are wondering: which ACE inhibitors are centrally acting? Here's your list:

Centrally-acting ACE inhibitors include captropril (Capoten®), fosinopril (Monopril®), lisinopril (Prinivil® or Zestri®), perindopril (Aceon®), ramipril (Altace®) and trandolapril (Mavik®).

Anyone going to get their high blood pressure drug changed as a result of this news?

Share |      Randall Parker, 2009 July 22 03:51 PM  Aging Drugs

Nick G said at July 23, 2009 9:06 AM:

hmm. I might try to get my father to change his.

Fat Man said at July 23, 2009 9:39 AM:

Nope. I am allergic to ACE inhibitors.

Lou Pagnucco said at July 25, 2009 9:12 AM:

(Randall, your headline should have also noted the negative effect of some ACEIs so as not to mislead topic surfers.)

Another similar class of anti-hypertensive medications, the ARBs (agiotensin receptor blockers), also may be effective.

ARBs might prevent, treat Alzheimer's

Interesting, also that ACE agonists have been proposed as Alzheimers therapy, since ACE cleaves some of the fibrils.

I am interested in finding out whether reputed natural ACE-inhibitors (e.g., hibiscus flavoids) cross the blood-brain-barrier. Also, whether berry flavonoids have any such effects.

Randall Parker said at July 25, 2009 9:31 AM:


I figure nobody who does not have high blood pressure is going to take an ACE inhibitor. Also, anyone who has high blood pressure who does not take a drug to lower their blood pressure is probably making a big mistake. Granted, there are side effects. But on average high blood pressure has much bigger side effects.

Natural ACE inhibitors: I wasn't aware. Berry flavonoids: If they do have similar effects I'm covered. I'm eating a lot of grapes, raisins, cranberries, prunes, and apples.

We need to find brain anti-inflammatories.

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