Effect of telmisartan on hypertensive dementia patients: an observational study
Keywords:Telmisartan, Hypertensive dementia, Mini-mental state examination score
Background: This was a prospective observational study done to observe the effects of telmisartan on cognitive function in hypertensive dementia patients.
Methods: The study included new diagnosed hypertensive and normotensive dementia patients. Patients comprised of four groups; hypertensive dementia patients taking telmisartan (group 1), hypertensive dementia patients taking donepezil and telmisartan (group 2), normotensive dementia patients taking donepezil (group 3) and normotensive dementia patients taking drugs which does not affect memory (group 4).Cognitive function of four groups were compared to each other at 4, 8 and 12 weeks.
Results: In group 1, 2 and 3 mini-mental state examination (MMSE) scores has increased by 1.69, 16.81, and 13.28 percent and in group 4 there is decrease in MMSE score by 6.03 percent in 12 weeks.
Conclusions: In this study we can conclude that telmisartan has dementia preventing propensity which is better than placebo but not as good as donepezil.
Richards SS, Sweat RA. Dementia. In Saddock NJ, Saddock VA, Ruiz P, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 9th ed. Philadelphia: Lippincot Williamams and Willkins; 2009: 1167.
Kennelly SP, Lawlor BA, Kenny RA. Blood pressure and dementia: a comprehensive review. Ther Adv Neurol Disord. 2009;2(4):241-60.
Mogi M, Iwanami J, Horiuchi M. Roles of Brain Angiotensin II in Cognitive Function and Dementia. Int J Hypertens. 2012;169649.
Tombaugh TN, McIntyre NJ. The Mini‐Mental State Examination: A Comprehensive Review. J Am Geriatrics Society. 1992;40:922-35.
Folstein M, Folstein S, Hugh MP. ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;2:89-98.
Wright JW, Harding JW. The brain RAS and Alzheimer’s disease. Exp Neurol. 2010;223:326-33.
Villapol S, Saavedra JM. Neuroprotective effects of angiotensin receptor blockers. Am J Hypertens. 2015;28:289-99.
Mogi M, Horiuchi M. Effects of angiotensin II receptor blockers ondementia. Hypertens Res. 2009;32:738-40.
Cacabelos R. Donepezil in Alzheimer’s disease: From conventional trials to pharmacogenetics. Neuropsychiatr Dis Treat. 2007;3:303-33.
Knowles J. Donepezil in Alzheimer's disease: an evidence-based review of its impact on clinical and economic outcomes. Core Evid. 2006;3:195-219.
Cutuli D, De BP, Caporali P, Tartaglione AM, Oddi D, Amato DFR, et al. Neuroprotective effects of donepezil against cholinergic depletion. Alzheimers Res Ther. 2013;24(5):50.
Kume K, Hanyu H, Sakurai H, Takada Y, Onuma T, Iwamoto T. Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer's disease. Geriatrics Gerontology Int. 2012;12(2):207-14.
Hajjar I, Brown L, Mack W, Chui H. Impact of angiotensin receptor blockers on Alzheimer’s disease neuropathology in a large brain autopsy series. Arch Neurol. 2012;69:1632-8.
Kishi T, Hirooka Y, Sunagawa K. Telmisartan protects against cognitive decline via up-regulation of brain-derived neurotrophic factor/tropomyosin-related kinase B in hippocampus of hypertensive rats. J Cardiology. 2012;60(6):489-94.
Ohno K, Amano Y, Kakuta H, Niimi T, Takakura S, Orita M, et al. Unique ‘delta lock’ structure of telmisartan is involved in its strongest binding affinity to angiotensin II type 1 receptor. Biochem Biophys Res Commun. 2011;404(1):434-7.
Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B, et al. SCOPE Study Group. J Hypertension. 2003;21(5):875-86.
Ho JK, Nation DA. Memory is preserved in older adults taking AT1receptor blockers. Alz Res Therapy. 2017;9:33.
Nation DA, Ho J, Yew B. Older adults taking AT1-receptor blockers exhibit reduced cerebral amyloid retention. J Alzheimers Dis. 2016;50:779-89.
Kehoe PG, Miners S, Love S. Angiotensins in Alzheimer’s disease - friendor foe. Trends Neurosci. 2009;32:619-28.
Oba R, Igarashi A, Kamata M, Nagata K, Takano S, Nakagawa H. The N-terminal active centre of human angiotensin-converting enzyme degrades Alzheimer amyloid β-peptide. Eur J Neurosci. 2005;21:733-40.
Davies NM, Kehoe PG, Shlomo BY, Martin RM. Associations of anti-hypertensive treatments with Alzheimer’s disease, vascular dementia, and other dementias. J Alzheimer’s Dis. 2011;26:699-708.
Anderson C, Teo K, Gao P, Arima H, Dans A, Unger T, et al. Renin angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease: analysis of data from the on target and transcend studies. Lancet Neurol. 2011;10:43-53.
Tzourio C, Anderson C, Chapman N, Woodward M, Neal B, Mahon MS, et al. Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovasculardisease. Arch Intern Med. 2003;163:1069-75.
Benson SC, Pershadsingh HA, Ho CI, Chittiboyina A, Desai P, Pravenec M, et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPAR gamma-modulating activity. Hypertension. 2004;43:993-1002.
Takagi, Hisato. Telmisartan as a metabolic sartan: The first meta-analysis of randomized controlled trials in metabolic syndrome. J Am Society Hypertension. 2013;7(3):229-35.
Kehoe PG, Blair PS, Howden B, Thomas DL. The Rationale and Design of the Reducing Pathology in Alzheimer's Disease through Angiotensin Targeting. Trial J Alzheimer’s Dis. 2018;61(2):803-14.