Assess the role of anti-hypertensive medications on progression of normal cognition to mild cognitive impairment (MCI) in the ADNI (Alzheimer’s Disease Neuroimaging Initiative) study, based on length of use.

This retrospective analysis focuses on data collected from 2005 to 2022 in the ADNI study. Medication history is evaluated for length of use of diuretics (thiazide, loop, and potassium-sparing), angiotensin-converting enzyme inhibitors (ACE-I), aldosterone receptor blockers (ARB), α-blockers that can treat hypertension, β-blockers, and calcium-channel blockers (CCB). Cognitive impairment severity was determined using clinical evaluation data. The data was evaluated via separate ordinal logistic regressions adjusting for patient-level clustering, along with age, gender, race/ethnicity, and follow-up time.

From 2005 to 2022, 440 participants were evaluated. The odds ratio of progressing to MCI based on length of use of thiazides was 0.84 (95% CI 0.75-0.95) per year, 0.97 (95% CI 0.86-1.09) per year for CCB, 0.91 (95% CI 0.86-0.98) per year for ACE-I, 0.86 (95% CI 0.77-0.98) per year for ARB, 0.91 (95% CI 0.85-0.99) per year for β-blockers, 0.87 (95% CI 0.75, 1.01) per year for α-blockers, 0.97 (95% CI 0.91, 1.04) per year for loop diuretics, and 1.03 (95% CI 0.87, 1.22) per year for potassium-sparing diuretics.

This ADNI study dataset analysis suggests that thiazide diuretics, ACE-inhibitors, aldosterone receptor blockers, and β-blockers may reduce risk of being diagnosed with mild cognitive impairment with increased length of use. Further investigation is needed to determine if these odds are independent of systolic blood pressure. Nevertheless, understanding the role anti-hypertensives play on dementia and MCI may be imperative to how we manage cognitive health.