CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
150
AFRICA
and perindopril can delay cognitive decline.
12
Likewise, the
brain-penetrating angiotensin receptor blockers (ARBs) counter
cognitive decline, as in the case of telmisartan.
11,12
The cellular
mechanisms whereby the RAAS inhibitors act on the brain are
still under study but experimentally include stress relief,
13,14
and
an anti-inflammatory benefit.
15,16
Conclusion
Cognitive function is one of the most important functions of
the activity of the healthy mind and brain.
14
On present data, it
is reasonable to give a centrally acting ACE inhibitor or an ARB
to a person with developing cognitive decline. The possible risk is
that of a modest rise in blood pressure, which could be treated by
lifestyle modification and/or drug therapy as needed. Solid data
from large, long-term, appropriately designed trials are required.
Lionel H Opie, MD, FRCP,
Hatter Institute for Cardiovascular Research in Africa,
Groote Schuur Hospital and University of Cape Town
Medical School, Cape Town, South Africa
References
1.
Opie LH, Dalby AJ. Cardiovascular prevention: lifestyle and statins –
competitors or companions?
S Afr Med J
2014;
104
: 168–173.
2.
Geerlings MI, Jonker C, Bouter LM, Adèr HJ, Schmand B. Association
between memory complaints and incident Alzheimer’s disease in elderly
people with normal baseline cognition.
Am J Psychiatry
1999;
156
:
531–537.
3.
Kulshreshtha A, Vaccarino V, Judd SE,
et al
. Life’s Simple 7 and risk
of incident stroke: the reasons for geographic and racial differences in
stroke study.
Stroke
2013;
44
: 1909–1914.
4.
Thacker EL, Gillett SR, Wadley VG,
et al.
The American Heart
Association life’s simple 7 and incident cognitive impairment: The
REasons for Geographic And Racial Differences in Stroke (REGARDS)
study.
J Am Heart Assoc
2014; 3:e000635.
5.
Matsumoto A, Satoh M, Kikuya M,
et al
. Day-to-day variability in
home blood pressure is associated with cognitive decline: the Ohasama
study.
Hypertension
2014;
63
: 1333–1338.
6.
Goldstein FC, Levey AI, Steenland NK. High blood pressure and cogni-
tive decline in mild cognitive impairment.
J Am Geriatr Soc
2013;
61
:
67–73. doi: 10.1111/jgs.12067.
7.
Zanchetti A, Liu L, Mancia G,
et al.
Blood pressure and low-density
lipoprotein-cholesterol lowering for prevention of strokes and cognitive
decline: a review of available trial evidence.
J Hypertens
2014, Jun 27.
[Epub ahead of print].
8.
Yagi S, Akaike M, Ise T, Ueda Y, Iwase T, Sata M. Renin–angiotensin–
aldosterone system has a pivotal role in cognitive impairment.
Hypertens
Res
2013;
36
: 753–758. doi: 10.1038/hr.2013.5.
9.
Gao Y, O’Caoimh R, Healy L, Kerins DM,
et al
. Effects of centrally
acting ACE inhibitors on the rate of cognitive decline in dementia.
Br
Med J Open
2013;
3
. pii: e002881. doi: 10.1136/bmjopen-2013-002881.
10. Steenland K, Zhao L, Goldstein FC, Levey AI. Statins and cognitive
decline in older adults with normal cognition or mild cognitive impair-
ment.
J Am Geriatr Soc
2013;
61
: 1449–1455. doi: 10.1111/jgs.12414.
11. Chataway J, Schuerer N, Alsanousi A,
et al.
Effect of high-dose simvas-
tatin on brain atrophy and disability in secondary progressive multiple
sclerosis (MS-STAT): a randomised, placebo-controlled, phase 2 trial.
Lancet
2014;
383
: 2213–2221. doi: 10.1016/S0140-6736(13)62242-4.
12. Opie LH, Gersh BG (eds). In:
Drugs for the Heart
, 8th edn. Philadelphia:
Elsevier, 2013: 570.
13. Wincewicz D, Braszko JJ. Telmisartan attenuates cognitive impairment
caused by chronic stress in rats.
Pharmacol Rep
2014;
66
: 436–441. doi:
10.1016/j.pharep.2013.11.00.
14. Wincewicz D, Braszko JJ. Angiotensin II AT1 receptor blockade by
telmisartan reduces impairment of spatial maze performance induced
by both acute and chronic stress.
J Renin Angiotensin Aldosterone
Syst
2014, Mar 12 [Epub ahead of print].
15. Opie LH.
Living Longer, Living Better; Exploring the Heart–Mind
Relationship
. Oxford: Oxford University Press, 2011, Ch 7: 137–169.
Online:
-
Connection/dp/0198525672.
16. Saavedra JM. Angiotensin II AT(1) receptor blockers ameliorate inflam-
matory stress: a beneficial effect for the treatment of brain disorders.
Cell Mol Neurobiol
2012;
32
: 667–681. doi: 10.1007/s10571-011.
