P1‐015: Are angiotensin AT1 receptor blockers better at preventing dementia than angiotensin converting enzyme inhibitors? An update
Bibliographic record
Abstract
Our Neurotherapeutics Expert Review (september2000) concluded that for cerebroprotection (stroke and dementia) angiotensin AT1Receptor Blocker(AT1RB) are better than angiotensin converting enzyme inhibitors(ACEI), independently of their blood pressure(BP) lowering effects. We reviewed since the literature and found 2 major recent cohort studies on that subject. a) the Cardiovascular Health Cognition Study(CVHCS) which showed that centrally active ACEI as ramipril and perindopril were unable to prevent dementia, in agreement with the results of the PROGRESS randomized trial comparing perindopril alone with placebo,(the relative risk of all dementia being 1.08%), as well as with those of the HYVET study in which the dual therapy “indapamide +/- perindopril”, compared with placebo, failed to decrease all dementia risk, in spite a 30% stroke risk reduction. Furthermore, CVHCS showed that non centrally active ACEIs, compared with non ACEI antihypertensive drugs(mainly thiazides and calcium channel blockers) were associated with greater risk of incident dementia (HR = 1.20 per year of exposition); (b) the VACognition Study(VACS)(Li et al, BMJ January 2010) have recently analyzed a huge cohort of 799 069 patients (75 years) without dementia at baseline, allowing to compare for 4 years, 3 antihypertensive(AHT) drug groups:AT1RB(11507), lisinopril(91 164), and a cardiovascular comparator one(696 398) using other ACEIs and other cardiovascular drugs. Whereas mean SBP was respectively 136,134,133mmHg, the Hazard Rates for incident dementia in the AT1RB group was 0.76(0.69-0.84),compared with the CVcomparator, and 0.81(0.73-0.90)compared with the lisinopril group. Furthermore, when compared with patients remaining on ACEI, patients switching to AT1RB significantly decreased their dementia risk (HR = 0.28(0.24-32)). For patients with dementia or Alzheimer disease at baseline, risk of admission to nursery home, was also lower with AT1RBs than in those with lisinopril(HR = 0.74;0,62-90) or than in the CVcomparator group(0.61;0.52-72). These two cohort studies reinforce the hypothesis that, independently of their BP lowering effect, AT1RBs are better than ACEIs (whether or not centrally active) at preventing and slowing down progression of dementia or Alzheimer disease. This should be confirmed by a large randomized trial, considering the limitations of cohort studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".