According to a recent investigation, medications that pass the blood-brain barrier have been found to improve cognition in older people. A paper published in Hypertension, the American Heart Association's journal, detailed the advantages of blood-brain barrier-crossing medicines and their association with preventing memory impairment in the elderly. The results established that hypertension is a risk factor for cognitive deterioration in older persons.

Hypertension and dementia

High blood pressure is associated with hypertension, which is a risk factor for cognitive deterioration in dementia patients. According to studies, hypertension manifests decades before dementia; hence, treating hypertension early on may have a long-term beneficial influence on brain function.

Types of BP-lowering drugs

Blood pressure-lowering drugs are classified into many types, including:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Calcium channel blockers
• Diuretics

Each type of antihypertensive drug functions differently, with some treatments penetrating the blood-brain barrier and others not. The purpose of this meta-analysis was to determine the potential cognitive benefits of blood-brain barrier-crossing renin-angiotensin system therapies versus non-penetrant pharmaceuticals.

The study examined fourteen cohorts from six countries: Australia, Canada, Germany, Ireland, Japan, and the United States. A total of 12,849 people were analysed and the ability for antihypertensive drugs to penetrate the blood-brain barrier was evaluated in cognitively normal participants who used anti-hypertensive medicines.

Attention, executive function, language, verbal memory acquisition, recall, mental condition, and processing speed were all examined. Adjustments for age, gender, and education were made, and meta-analyses were employed. ACE inhibitors and ARBs had superior memory recall compared to other antihypertensives.

Key insights

1. These results provide the strongest evidence to date that brain-penetrant ACE inhibitors and angiotensin receptor blockers are associated with improved memory. It implies that persons with hypertension who take drugs that pass the blood-brain barrier may be protected against cognitive loss.
2. Drugs targeting the renin-angiotensin system, such as AT1 receptor blockers and ACE inhibitors, were identified as having a beneficial influence on future cognitive performance. The medications' effects on a variety of cognitive domains were assessed, including attention, language, verbal memory, learning, and recall.
3. While research on ARB and ACE inhibitors indicate that these medications may have the most effect on long-term cognition, other studies have shown the advantages of calcium channel blockers and diuretics in lowering the risk of dementia.
4. Over a three-year period of follow-up, older persons receiving blood-brain barrier-crossing renin-angiotensin pharmaceuticals had superior memory recall compared to those taking non-penetrant meds.

The findings show a relationship between renin-angiotensin medicines that pass the blood-brain barrier and decreased memory deterioration.

This article was originally published on 14th December 2021.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.