Abstract
Abstract
Purpose of Review
To provide an overview of the association between angiotensin II receptor blocker (ARB) use and cognitive outcomes.
Recent Findings
ARBs have previously shown greater neuroprotection compared to other anti-hypertensive classes. The benefits are primarily attributed to the ARB’s effect on modulating the renin-angiotensin system via inhibiting the Ang II/AT1R pathway and activating the Ang II/AT2R, Ang IV/AT4R, and Ang-(1–7)/MasR pathways. These interactions are associated with pleiotropic neurocognitive benefits, including reduced β-amyloid accumulation and abnormal hyperphosphorylation of tau, ameliorated brain hypo-fusion, reduced neuroinflammation and synaptic dysfunction, better neurotoxin clearing, and blood–brain barrier function restoration. While ACEis also inhibit AT1R, they simultaneously lower Ang II and block the Ang II/AT2R and Ang IV/AT4R pathways that counterbalance the potential benefits.
Summary
ARBs may be considered an adjunctive approach for neuroprotection. This preliminary evidence, coupled with their underlying mechanistic pathways, emphasizes the need for future long-term randomized trials to yield more definitive results.
Publisher
Springer Science and Business Media LLC
Reference98 articles.
1. Evans DA, Bennett DA, Wilson RS, et al. Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status. Arch Neurol. 2003;60:185–9.
2. World Health Organization (WHO). Dementia -key fact. March 2023. Accessed from: https://www.who.int/news-room/fact-sheets/detail/dementia#:~:text=Key%20facts,injuries%20that%20affect%20the%20brain. 20 Apr 2023.
3. Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C. Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol. 2014;13:788–94.
4. Wahidi N, Lerner AJ. Blood pressure control and protection of the aging brain. Neurotherapeutics. 2019;16:569–79.
5. Ungvari Z, Toth P, Tarantini S, et al. Hypertension-induced cognitive impairment: from pathophysiology to public health. Nat Rev Nephrol. 2021;17:639–54.