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Antihypertensive Medication Use and Incident Alzheimer Disease
The Cache County Study
Ara S. Khachaturian, PhD;
Peter P. Zandi, PhD;
Constantine G. Lyketsos, MD, MHS;
Kathleen M. Hayden, PhD;
Ingmar Skoog, MD, PhD;
Maria C. Norton, PhD;
JoAnn T. Tschanz, PhD;
Lawrence S. Mayer, MD;
Kathleen A. Welsh-Bohmer, PhD;
John C. S. Breitner, MD; for the Cache County Study Group
Arch Neurol. 2006;63:(doi:10.1001/archneur.63.5.noc60013).
Background Recent reports suggest that antihypertensive (AH) medications may reduce the risk of dementing illnesses.
Objective To examine the relationship of AH medication use with incidence of Alzheimer disease (AD) among the elderly population (aged 65 years and older) of Cache County, Utah, and to examine whether the relationship varies with different classes of AH medications.
Methods After an initial (wave 1) multistage assessment (1995 through 1997) to identify prevalent cases of dementia, we used similar methods 3 years later (wave 2) to identify 104 incident cases of AD among the 3308 survivors. At the baseline assessment, we obtained a detailed drug inventory from the study participants. We carried out discrete time survival analyses to examine the association between the use of AH medications (including angiotensin converting enzyme inhibitors,  -blockers, calcium channel blockers, and diuretics) at baseline with subsequent risk of AD.
Results Use of any AH medication at baseline was associated with lower incidence of AD (adjusted hazard ratio, 0.64; 95% confidence interval, 0.41-0.98). Examination of medication subclasses showed that use of diuretics (adjusted hazard ratio, 0.57; 95% confidence interval, 0.33-0.94), and specifically potassium-sparing diuretics (adjusted hazard ratio, 0.26; 95% confidence interval, 0.08-0.64), was associated with the greatest reduction in risk of AD. Corresponding analysis with a fully examined subsample controlling for blood pressure measurements did not substantially change our findings.
Conclusions These data suggest that AH medications, and specifically potassium-sparing diuretics, are associated with reduced incidence of AD. Because the latter association is a new finding, it requires confirmation in further study.
Published online March 13, 2006 (doi:10.1001/archneur.63.5.noc60013).
Author Affiliations: Khachaturian and Associates, Inc, Potomac, Md (Dr Khachaturian); Department of Mental Health, Bloomberg School of Public Health (Dr Zandi), and Division of Geriatric Psychiatry, Department of Psychiatry and Behavioral Sciences (Drs Lyketsos and Mayer), School of Medicine, Johns Hopkins University, Baltimore, Md; Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC (Drs Hayden and Welsh-Bohmer); Institute of Clinical Neurosciences, Göteborg University, Göteborg, Sweden (Dr Skoog); Department of Psychology (Dr Norton), Center for Epidemiologic Studies (Drs Norton and Tschanz), and Department of Family, Human and Consumer Sciences (Dr Norton), Utah State University, Logan; and VA Puget Sound Health Care System, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Dr Breitner).
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