En español | Older adults who take certain blood pressure medications could experience a slight benefit when it comes to memory, a new study suggests, adding to growing evidence that blood pressure and brain health go hand in hand.
Researchers analyzed data from 14 studies of nearly 12,900 adults 50 and older with hypertension and found that those who took an angiotensin-converting-enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) that crossed the blood-brain barrier — a border of cells that prevents many substances in the bloodstream from entering the brain — had better memory recall across a three-year span than people who took ACE inhibitors or ARBs that stayed in the bloodstream. Eight blood pressure medications in all were identified as potentially benefitting memory. The findings were published June 21 in the journal Hypertension.
Exploring benefits beyond blood pressure control
High blood pressure is a risk factor for cognitive decline and dementia, and research shows that lowering it can help curb those risks. Most notably, a large federally funded trial found that intensively treating high blood pressure reduced cases of mild cognitive impairment, a precursor to dementia, by 19 percent.
8 Blood Pressure Drugs Linked to Better Memory
- Captopril (Capoten)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, Zestril)
- Perindopril (Aceon)
- Ramipril (Altace)
- Trandolapril (Mavik)
- Telmisartan (Micardis)
- Candesartan (Atacand)
Source: Hypertension; brand names are listed in parentheses.
Whether certain blood pressure medications come with added benefits for the brain is still in question. But this latest study “gets us one step closer to better understanding” the relationship between blood pressure and brain health and the potential influence medications may have, says Dave Dixon, associate professor and vice chair for clinical services at Virginia Commonwealth University's School of Pharmacy, who was not involved in the study.
Nearly half of adults in the U.S. have high blood pressure, and most take medicine to lower it, federal data shows. High blood pressure is defined as 130/80 millimeters of mercury (mm Hg) or higher. ACE inhibitors and ARBs are just two classes of blood pressure-lowering drugs; they work by acting on the body's renin-angiotensin system, which regulates blood pressure.
A handful of medicines in these two classes have properties that enable them to penetrate the brain, where they could have a localized effect, explains study coauthor Daniel Nation, an associate professor of psychological science at the University of California, Irvine — especially because in the brain, the renin-angiotensin system “is believed to be involved in functions critical to cognition,” the researchers write.
What they found in their meta-analysis is that adults who took the brain-penetrating ACE inhibitors or ARBs had better memory recall over a three-year follow-up than those who took blood pressure medication that didn't cross the blood-brain barrier.
"This is one of these situations where it may be that there's just this other benefit that really is distinct, based on the fact that [the medicine] is getting into the brain and hitting those pathways,” Nation says about the results.
Researchers didn't see a difference between the two groups in other cognitive parameters such as learning, language skills and executive function. However, adults who took the drugs that didn't cross the blood-brain barrier scored better on attention, which the researchers note was unexpected and warrants further investigation.
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The bottom line: Blood pressure control is key
Paul Whelton, M.D., a professor at Tulane University's School of Public Health and Tropical Medicine, who has led many blood pressure trials, calls the latest results “interesting” and “hypothesis generating,” but cautions the public not to overinterpret the findings.
Typically, health care providers don't prescribe blood pressure medicines based on their ability to cross the blood-brain barrier, the report's authors write, and Whelton doesn't expect this study to change that practice.
"I don't think we really have good information to suggest that there's a particular class of drugs that is preferred for prevention of dementia,” says Whelton, who also wasn't involved in the study. “And of course [in older adults], most people are going to require two or three drugs anyway. It would be very unusual that you could manage hypertension in this age range with a single agent.”
What the new research does reinforce, however, is that blood pressure reduction plays a key role in preserving brain health. “The study reminds us that one of the most important things that we can do to reduce the risk of cognitive impairment is to control blood pressure over long periods of time,” Dixon says.
Whelton points out that this can be accomplished with lifestyle modifications. A healthy diet, regular exercise, and cutting down on alcohol and salt can all help improve blood pressure.
Medications can also help. And while emerging evidence suggests that blood pressure drugs may offer additional brain benefits, more studies “are warranted to really confirm these findings and to really change day-to-day practice,” Dixon adds.
What is high blood pressure?
|Category||Systolic Blood Pressure||Diastolic Blood Pressure|
|Normal||<120 mm Hg||<80 mm Hg|
|Elevated||120-129 mm Hg||<80 mm Hg|
|Stage 1 Hypertension||130-139 mm Hg||80-89 mm Hg|
|Stage 2 Hypertension||≥140 mm Hg||≥90 mm Hg|
Rachel Nania writes about health care and health policy for AARP. Previously, she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.