Correspondence |

Association Between Angiotensin Receptor Blockers and Better Cognitive Outcome: Urgent Need for a Randomized Trial

Roxana Oprisiu, MD; Albert Fournier, MD; Jean Michel Achard, MD, PhD; Sandra E. Black, MD, FRCPC; Jean-Marie Serot, MD, PhD; Olivier Godefroy, MD, PhD
JAMA Neurol. 2013;70(3):413-414. doi:10.1001/jamaneurol.2013.1804.
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We are very interested in the autopsy study by Hajjar et al1: to our knowledge, it provides the first clinical translational evidence for an association between angiotensin receptor blockers (ARBs) and better cognitive performance, as well as reduced brain amyloid accumulation post mortem, when compared with hypertensive patients treated with other drugs or not treated at all.

These better results with ARB treatment compared with angiotensin-converting enzyme inhibitors (ACEIs) are compatible with data from transgenic mice showing that valsartan treatment enhances the expression of insulin-degrading enzyme, which also degrades amyloid peptides,2 whereas ACEIs increase amyloid pathology by blocking angiotensin-converting enzyme, which catabolizes toxic amyloid-β 42 into less toxic amyloid-β 40 peptides. Angiotensin receptor blockers also increase angiotensin II and IV, which have memory-protective effects by activation of angiotensin AT2 and AT4 receptors.3

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