Renin-angiotensin system-targeting antihypertensive drugs and risk of vascular cognitive impairment: A meta-analysis.

Abstract Objectives To evaluate the effects of renin–angiotensin system (RAS)-targeting antihypertensive drugs and its classes on the incidence of vascular cognitive impairment (VCI). Methods Pubmed, Embase, and Cochrane Library database of selected articles, and previous systematic reviews through May 2015 were searched. Studies that evaluated the association between use of RAS-targeting drugs and VCI were included. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using fixed effects models or random effects models. Results In all studies as a whole, the use of RAS-targeting drugs was significantly associated with a reduced risk of VCI (RR, 0.87; 95% CI, 0.75–0.98) and vascular dementia (VD) (RR, 0.78; 95% CI, 0.64–0.93), compared no use of RAS-targeting drugs. Subgroup analysis showed that subjects with Angiotensin-Converting Enzyme Inhibitors (ACEI) use significantly associated with a reduced incidence of VCI (RR, 0.81; 95% CI 0.70–0.91) and VD (RR, 0.75; 95% CI, 0.57–0.93); however, subjects with Angiotensin Receptor Blockers (ARB) use had not this effect on VCI (RR, 0.94; 95% CI 0.76–1.13) or VD (RR, 0.94; 95% CI, 0.45–1.44). In an analysis of subgroups, case-control studies found that the use of RAS-targeting drugs could effectively decrease the incidence of VCI (RR, 0.77; 95% CI 0.66–0.87) and VD (RR, 0.77; 95% CI, 0.66–0.88); however, the randomized trials alone showed no significant effect on the incidence of VCI (RR, 0.94; 95% CI 0.82–1.07) or VD (RR, 0.94; 95% CI, 0.35–1.53). Meanwhile, in an analysis of cognitive impairment of vascular origin (VaCI), no significant association was found between RAS-targeting drugs, ACEI, or ARB and the incidence of VaCI. Conclusion RAS-targeting drugs treatment may produce remarkable efficacy on reducing the incidence of VCI and VD. Meanwhile, ACEI use, rather than ARB use, significantly protects against VCI and VD incidence. However, among the classes of RAS-targeting drugs, neither ACEI nor ARB plays protective role in VaCI incidence. Further more RCTs are required to reliably establish whether RAS-targeting drugs use decreases the risk of VCI (VD and VaCI).