ramipril and Dementia

Recent meta-analyses have examined the relationship between lowering blood pressure (BP) and reducing the risk for stroke and dementia. Studies have shown that drug therapy that successfully reduces systolic BP by only 10 mm Hg results in significant protection against stroke. Controversy exists regarding the most effective regimen, with supporters for the standards of diuretics and beta-blockers, or angiotensin-converting enzyme inhibitors and calcium-channel blockers, pitted against the increasing evidence of the effectiveness of angiotensin-receptor blockers or statins. Additionally, the most effective strategy for delivery of BP-reducing therapy is being examined, with some studies supporting use of standards for primary prevention of stroke and reserving the newer drugs for secondary prevention. Ultimately, however, all agree that for patients with the highest risk for cardiovascular and cerebrovascular complications, the strategy of intervention is immaterial, and drug therapy, including low-dose aspirin, is vital.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Benzimidazoles; Biphenyl Compounds; Blood Pressure; Calcium Channel Blockers; Clinical Trials as Topic; Cognition; Dementia; Hydrochlorothiazide; Ramipril; Stroke; Tetrazoles; Verapamil

Avoidance of death, disability, dementia, and cognitive dysfunction (DDCD) are high priorities for people in aging societies. Evidence is mounting that these conditions are associated with impaired glycemic control.. The aim of this study was to assess the strength of relationship between the degree of glucose elevation and the development of the composite elements of DDCD that impede successful/healthy aging in a population at high risk for cardiovascular disease. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURE: The relationship between baseline fasting plasma glucose values and DDCD was determined among 31 227 participants of the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE intolerant Subjects With Cardiovascular Disease studies followed up for a median of 4.7 years. Several statistical models were used for the entire cohort and for those with and without normal fasting plasma glucose (ie, < 5.6 mmol/L) or a history of diabetes mellitus.. After adjusting for age and sex, a diagnosis of diabetes mellitus was associated with an approximately 1.6 greater odds of DDCD; every 1 mmol/L higher baseline fasting plasma glucose value was associated with a 1.09 (95% confidence interval 1.07, 1.10) greater odds. These associations persisted in the multivariate models (a 1.08 95% confidence interval 1.07, 1.1 greater odds after adjustment for age, sex, education, and depression).. In individuals with high cardiovascular risk, a direct relationship exists between levels of dysglycemia and the risk of DDCD. Further research is needed to understand the mechanisms underlying such an association and whether benefits can be derived from preventative strategies.

Topics: Aged; Aged, 80 and over; Aging; Benzimidazoles; Benzoates; Cardiovascular Diseases; Chronic Disease; Cognition Disorders; Dementia; Disabled Persons; Female; Glucose Metabolism Disorders; Humans; Male; Middle Aged; Ramipril; Risk Factors; Telmisartan

To examine the association between Mini-Mental State Examination (MMSE) score and motor vehicle crash (MVC) risk in a large cohort of community-dwelling participants with cardiovascular disease (CVD) or diabetes mellitus.. Prospective observational study.. Participants enrolled in the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial and Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease clinical trial, which included individuals aged 55 and older with CVD or diabetes mellitus.. Totally 17,538 frequent drivers (defined as driving at least once per week) who had completed a baseline MMSE.. Involvement in a MVC as the driver.. Baseline MMSE score was divided into four categories: 30, 27-29, 24-26, and <24. The median MMSE score was 29 (interquartile range 27-30), and 726 (4.1%) has a MMSE score of less than 24 at baseline. After a mean follow-up of 4.5 years, 1,068 (6.1%) participants were drivers in a MVC. Lower scores were not associated with future MVCs (MMSE score 29-27, hazard ratio (HR)=1.06, 95% confidence interval (CI)=0.93-1.22); MMSE score 26-24, HR=0.96, 95% CI=0.78-1.19; MMSE score<24, HR=0.72, 95% CI=0.50-1.05) on multivariable analysis. A MVC within the previous 2 years (HR=2.68, 95% CI=2.29-3.13) was the strongest predictor of future MVCs. Other clinical factors associated with greater MVC risk were depression, falls within the previous year, sleep apnea, and lower baseline systolic blood pressure.. In a population of frequent drivers, the MMSE does not predict MVCs. Other clinical factors have a stronger association with MVC risk.

Topics: Accidents, Traffic; Aged; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Automobile Driving; Benzimidazoles; Benzoates; Cardiovascular Diseases; Dementia; Diabetes Complications; Female; Humans; Male; Neuropsychological Tests; Predictive Value of Tests; Prospective Studies; Ramipril; Risk; Telmisartan