Angiotensin receptor blockers and dementia risk in older adults: A target trial emulation
Hisashi Noma, Hiroshi Sunada, Taiki Sugimoto, Takao Fujisawa, Futoshi Oda, Megumi Maeda, Haruhisa FukudaAbstract
INTRODUCTION
Whether antihypertensive drug class influences dementia risk beyond blood pressure lowering remains uncertain.
METHODS
We emulated a target trial comparing new initiation of angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) among dementia‐free adults aged ≥65 years in a nationwide Japanese database. Weighted discrete‐time hazards models estimated intention‐to‐treat and per‐protocol effects, accounting for censoring and death.
RESULTS
Among 52,019 eligible new users followed for a median of 3.6 years, 3524 incident dementia events occurred. ARB initiation was associated with lower all‐cause dementia risk than CCB initiation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.852–0.985), with similar achieved blood pressure. For Alzheimer's disease (2231 events), the association was not statistically significant (HR, 0.930; 95% CI, 0.849–1.018). The association was stronger for vascular dementia (129 events; HR, 0.617; 95% CI, 0.409–0.930).
DISCUSSION
ARB initiation was associated with modestly lower dementia risk, particularly vascular dementia, versus CCB initiation.