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Editor's Correspondence
January 11, 2010

Designing Appropriate Clinical Trials to Assess ACEI Use and Cognitive Decline in Older Adults With Hypertension

Arch Intern Med. 2010;170(1):107. doi:10.1001/archinternmed.2009.463

Sink et al1 report that exposure to angiotensin-converting enzyme inhibitors (ACEIs) is not associated with dementia risk or cognitive decline in older hypertensive adults compared with other antihypertensive drugs. Centrally active ACEIs, ie, those that cross the blood-brain barrier (BBB) (animal data), reduced cognitive decline, whereas noncentrally acting ACEIs (BBB impermeable) were associated with greater risk of incident dementia and disability in instrumental activities of daily living.1 These effects were independent of blood pressure regulation and prompted a call for a randomized clinical trial of centrally active ACEIs in the prevention of cognitive decline and dementia.1

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