Teaching old drugs new tricks: Do cardiovascular medications effect cognitive decline?

Background Cardiovascular disease affects multiple organs beyond those of the cardiovascular system including the brain. However, the mechanisms linking cardiovascular disease and cognitive decline are still poorly understood. Studies suggest specific cardiovascular medications targeting different mechanisms may slow cognitive decline and reduce dementia risk in later life. We investigated the association of specific blood pressure (BP) lowering medications and cognitive decline over time in a nation‐wide study of aging. Method We utilised the English Longitudinal Study of Ageing cohort accessed via the Dementia’s platform UK. At baseline this cohort contained over 10,000 dementia‐free adults older than 50 years old [mean age 65 years, 54% female, 39% hypertension] followed up to 15 years. We included individuals with either a diagnosis of hypertension, taking any BP lowering medications or having systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg [mean 144 SBP and 79 DBP mmHg]. Cognition was assessed at multiple time points using memory and executive function tests. We examined the following drug classes: angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers, beta‐blockers, calcium channel blockers, diuretics and any other blood lowering medications. We applied inverse probability weighting to linear mixed effect models to assess treatment effects and to control for factors that may influence the propensity to be treated with a BP‐lowering medication. Result Participants taking any BP‐lowering medication, regardless of drug class, had slower cognitive decline compared to non‐drug users. For example, drug users had an increase of 0.032 per year for memory tests (p value 0.0016). Comparing specific drug classes with no drug users or between the other drug classes, the overall trend indicates most drug classes slowed cognitive decline, however the results lacked statistical significance. Conclusion We have established BP‐lowering medications effect cognitive decline. Further follow up is required to further understand the specific drug class effects using other real world datasets. This work provides an evidence base for further exploration into the management of cardiovascular health as a preventative strategy for maintaining brain health and slowing cognitive decline. In turn, this could inform health policy strategies for reducing dementia risk earlier in life.