Researchers followed over 51,000 people with high blood pressure for more than 11 years to compare two common types of blood pressure medications. They found that people taking a class of drugs called ARBs had about 28% lower chances of developing dementia compared to those taking ACEIs. The study suggests that the specific type of blood pressure medication you take might affect your brain health as you age, though doctors say more research is needed before changing anyone’s medications based on these findings alone.
The Quick Take
- What they studied: Whether two common types of blood pressure medications—ARBs and ACEIs—affect the risk of developing dementia differently in older adults
- Who participated: 51,574 people aged 45 and older with high blood pressure who started taking either ARBs or ACEIs between 2004 and 2022. The average age was 66 years old, and about half were women
- Key finding: People taking ARBs had a 28% lower risk of developing dementia compared to those taking ACEIs over the 11-year study period. Some specific ARB medications showed even stronger protection
- What it means for you: If you take blood pressure medication, this suggests your choice of medication might influence your brain health long-term. However, don’t change your medications without talking to your doctor—they know your full health picture and can make the best recommendation for you
The Research Details
This was a long-term observation study where researchers tracked real people over time rather than randomly assigning them to different medications. They followed 51,574 people with high blood pressure who started taking either ARBs or ACEIs between 2004 and 2022, watching them for an average of 11 years to see who developed dementia.
To make the comparison fair, researchers used a statistical technique called propensity score matching. Think of it like this: they identified people taking ARBs and people taking ACEIs who were similar in age, gender, health conditions, and lifestyle factors. This way, they could compare apples to apples rather than apples to oranges.
The researchers also accounted for important lifestyle factors like diet and physical activity, and they used advanced statistical methods to handle situations where people died during the study or stopped taking their medications.
This approach is important because it follows real people in real life over many years, which is how medications actually work in the world. Unlike a short-term lab study, this shows what happens to people’s brains over a decade or more. The long follow-up period is especially valuable for studying dementia, which develops slowly over time.
This study has several strengths: it included a very large number of people (over 51,000), followed them for more than a decade, and carefully controlled for other factors that might affect dementia risk. The researchers also tested their findings in different groups of people (men vs. women) and used multiple statistical methods to confirm their results. However, this was an observation study rather than a randomized trial, meaning people chose their medications rather than being randomly assigned, which could introduce some bias even with the matching techniques used.
What the Results Show
The main finding was clear: people taking ARBs had significantly lower dementia risk compared to those taking ACEIs. Specifically, ARB users had about 28% lower risk (the researchers call this a hazard ratio of 0.72). This difference was statistically significant, meaning it’s very unlikely to have happened by chance.
When researchers looked at specific medications, some ARBs showed even stronger protection. For example, olmesartan, candesartan, telmisartan, and irbesartan all showed 50-68% lower dementia risk compared to lisinopril (a common ACEI). Interestingly, one ACEI called perindopril also showed lower dementia risk compared to lisinopril, suggesting that not all medications in the same class work exactly the same way.
One surprising finding was that captopril, another ACEI, appeared to be associated with higher dementia risk, though this finding was based on fewer people and needs confirmation in future studies.
Importantly, these protective effects of ARBs held true even after accounting for diet and physical activity, suggesting the medication itself—not just lifestyle factors—may be responsible for the difference.
The researchers tested their main findings in different groups of people to make sure the results were consistent. The protective effect of ARBs was similar in both men and women, and held up when they excluded people whose high blood pressure was only diagnosed because they were taking medication. They also used different statistical methods to analyze the data, and all approaches showed similar results, which increases confidence in the findings.
Previous research has suggested that blood pressure control itself is important for brain health, but this study goes further by suggesting that the type of medication matters too. Some earlier studies hinted that ARBs might have brain-protective benefits beyond just lowering blood pressure, and this large, long-term study provides stronger evidence for that idea. However, most previous studies were shorter or smaller, so this research adds important new information to the field.
While this study is large and long-term, it has some important limitations. First, it’s an observation study where people chose their medications rather than being randomly assigned, so we can’t be completely certain the medications caused the difference in dementia risk—other unmeasured factors could be involved. Second, the study was conducted in Australia, so results might differ in other populations. Third, some specific medications had relatively few people taking them, making those findings less reliable. Finally, the researchers couldn’t directly measure dementia diagnoses in all cases, relying partly on hospital records and medication use. The authors emphasize that randomized controlled trials are needed to confirm these findings before doctors should change treatment recommendations.
The Bottom Line
Based on this research, there is moderate evidence that ARBs may offer additional brain protection compared to ACEIs for people with high blood pressure. However, the evidence is not yet strong enough to recommend switching medications solely based on dementia prevention. If you currently take an ACEI and are concerned about dementia risk, discuss with your doctor whether an ARB might be appropriate for you—they can consider your complete health picture, other medications, and individual risk factors. If you already take an ARB, there’s no need to change based on this study.
This research is most relevant to people aged 45 and older with high blood pressure who are currently taking or considering starting blood pressure medication. It may be especially relevant for people with family history of dementia or other dementia risk factors. People with certain kidney conditions, pregnancy, or specific allergies to these medications should not make changes without medical guidance. This research does not apply to people without high blood pressure.
Dementia develops slowly over many years, so any protective benefits from medication would likely take years to become apparent. The people in this study were followed for an average of 11 years before differences in dementia risk became clear. You shouldn’t expect to notice changes in your brain health quickly—this is a long-term consideration for brain aging.
Want to Apply This Research?
- Track your blood pressure readings weekly and note which medication you’re taking. Over time, you can monitor whether your blood pressure stays well-controlled, which is the primary goal of these medications. You can also track cognitive health markers like memory concerns or doctor visits related to brain health.
- Use the app to set reminders to take your blood pressure medication consistently every day, since the study only counted people who took their medication at least 80% of the time. Consistency matters for both blood pressure control and potential brain benefits. Also track lifestyle factors like physical activity and diet quality, which work together with medication for brain health.
- Create a long-term tracking dashboard that monitors: (1) medication adherence—did you take your pills as prescribed? (2) blood pressure readings—are they in your target range? (3) cognitive health check-ins—any changes in memory or thinking? (4) lifestyle factors—exercise minutes per week and diet quality. Review these quarterly with your healthcare provider to ensure your treatment plan is working well.
This research suggests a possible connection between blood pressure medication type and dementia risk, but it is not definitive proof that changing medications will prevent dementia. Do not change, start, or stop any blood pressure medication without consulting your doctor. This study was observational rather than a randomized trial, so while the findings are interesting, they need confirmation through additional research. Your doctor knows your complete medical history and can best advise whether any medication changes are appropriate for you. If you have concerns about dementia risk or your current medications, schedule an appointment with your healthcare provider to discuss your individual situation.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.