RAS inhibitors linked to lower dementia risk than CCBs
Incidence of all-cause dementia was 1.26 per 1000 person-years with RAS inhibitors versus 1.89 with calcium channel blockers (HR 0.68).
Drugs & Aging
In a multicenter study of 164,918 adults with hypertension, researchers evaluated whether renin-angiotensin system inhibitors (RASIs) reduced dementia risk compared with calcium channel blockers (CCBs). The team matched 54,042 propensity-score pairs of previously untreated patients initiating either drug class across 28 hospitals. Participants had a median age of 65 years and were followed for a median of 516 days.
During follow-up, 344 incident dementia cases occurred. RASI initiators showed a lower risk of all-cause dementia (HR 0.68, 95% CI 0.55–0.84) and Alzheimer's disease (HR 0.59, 95% CI 0.43–0.81) compared with CCB initiators. However, the risk of vascular dementia did not differ significantly between groups (HR 0.74, 95% CI 0.50–1.11). Dementia risk was also similar between patients starting angiotensin-converting enzyme inhibitors and those starting angiotensin II receptor blockers.
Why it matters
Hypertension is a major modifiable risk factor for age-related cognitive decline and neurodegenerative disease. Determining whether specific blood pressure medications offer distinct neuroprotective benefits helps clarify the biological pathways linking vascular control to brain aging.
Caveats
The findings come from observational health records with a relatively short median follow-up of 516 days. The authors state that further validation is warranted.
The paper
Nanfang Hospital · Southern Medical University
Drugs & Aging · 28 Sep 2026