Associations between brain amyloid accumulation and the use of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers

Some studies suggest that angiotensin II type 1 receptor blockers (ARBs) may protect against memory decline more than angiotensin-converting enzyme inhibitors (ACE-Is), but few have examined possible mechanisms. We assessed longitudinal differences between ARB versus ACE-I users in global and sub-regional amyloid-beta accumulation by F-18-florbetapir. In cognitively normal older adults (n= 142), propensity-weighted linear mixed-effects models showed that ARB versus ACE-I use was associated with slower amyloid-beta accumulation in the cortex, and specifically in the caudal anterior cingulate and pre-cuneus, and in the precentral and postcentral gyri. In amyloid-positive participants with Alzheimer's disease dementia or mild cognitive impairment (n = 169), ARB versus ACE-I use was not associated with different rates of amyloid-beta accumulation. Apolipoprotein E epsilon 4 carrier status explained some heterogeneity in the different rates of amyloid-beta accumulation between users of ARBs versus ACE-Is in the study. Replicative studies and clinical trials are warranted to confirm potential benefits of ARBs on rates of amyloid-beta accumulation in the contexts of Alzheimer's disease prevention and treatment. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

This study suggests that ARBs may be more effective than ACE-Is in protecting against memory decline by slowing amyloid-beta accumulation in certain brain regions. Differences in amyloid-beta accumulation rates between ARB and ACE-I users may be influenced by apolipoprotein E epsilon 4 carrier status. Further studies and clinical trials are needed to confirm the potential benefits of ARBs in Alzheimer's disease prevention and treatment.