ArticleAlzheimer's & dementia : the journal of the Alzheimer's Association2026
Angiotensin receptor blockers and dementia risk in older adults: A target trial emulation.
Article in Alzheimer's & dementia : the journal of the Alzheimer's Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionWhether antihypertensive drug class influences dementia risk beyond blood pressure lowering remains uncertain.
methodsWe emulated a target trial comparing new initiation of angiotensin receptor blockers (ARBs) versus calcium channel blockers (CCBs) among dementia-free adults aged ≥65 years in a nationwide Japanese database. Weighted discrete-time hazards models estimated intention-to-treat and per-protocol effects, accounting for censoring and death.
resultsAmong 52,019 eligible new users followed for a median of 3.6 years, 3524 incident dementia events occurred. ARB initiation was associated with lower all-cause dementia risk than CCB initiation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.852-0.985), with similar achieved blood pressure. For Alzheimer's disease (2231 events), the association was not statistically significant (HR, 0.930; 95% CI, 0.849-1.018). The association was stronger for vascular dementia (129 events; HR, 0.617; 95% CI, 0.409-0.930). DISCUSSION: ARB initiation was associated with modestly lower dementia risk, particularly vascular dementia, versus CCB initiation.
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