Angiotensin II Receptor Blockers and the Risk of Alzheimer's Disease Progression: A Population-Based Cohort Study.

We investigated the effects of angiotensin II receptor blockers (ARBs) on the progression of Alzheimer's disease (AD). This retrospective cohort study used data from the Korean nationwide claims data to identify patients with AD aged 60-79 years in 2010. ARB users and nonusers were 1:1 propensity score matched. Cox proportional hazards regression evaluated AD progression, defined as memantine initiation and mortality. Active-comparator and dose-response analyses were conducted. ARB use was associated with lower risks of memantine initiation (hazard ratio [HR] = 0.79; 95% confidence interval [CI] = 0.70-0.89) and mortality (HR = 0.83; 95% CI = 0.76-0.89). Cumulative exposure analyses showed stronger associations in the highest exposure categories, including 2-3 years of ARB use and ≥ 2 DDD-years, whereas associations in the lower exposure categories were not statistically significant. In active-comparator analyses, ARBs were associated with lower mortality risk than ACE inhibitors and beta-blockers, but not with dihydropyridine calcium channel blockers (CCBs). ARB use may be a reasonable antihypertensive choice in patients with AD, although the comparable outcomes between ARBs and CCBs suggest that these associations may not be unique to ARBs and may instead reflect shared blood pressure-lowering and vascular effects. Further prospective research is warranted to optimize antihypertensive selection in patients with AD.