PT - JOURNAL ARTICLE AU - N Davies AU - P Kehoe AU - Y Ben-Shlomo AU - R Martin TI - O4-4.5 Associations of angiotensin-II receptor blockers and ACE inhibitors with Alzheimer's disease: a nested case-control study within the UK general practice research database AID - 10.1136/jech.2011.142976b.28 DP - 2011 Aug 01 TA - Journal of Epidemiology and Community Health PG - A45--A45 VI - 65 IP - Suppl 1 4099 - http://jech.bmj.com/content/65/Suppl_1/A45.1.short 4100 - http://jech.bmj.com/content/65/Suppl_1/A45.1.full SO - J Epidemiol Community Health2011 Aug 01; 65 AB - Objectives To investigate whether angiotensin II receptor blockers (ARBs) and ACE inhibitors (ACE-Is) are more strongly associated with Alzheimer's disease (AD) than other anti-hypertensive drugs.Methods Nested case-control analysis within the UK general practice research database (n≈10 million), with prospectively recorded anti-hypertensive prescribing data. Cases aged ≥60 years and diagnosed between 1997 and 2008 (5797 with AD, 2186 with vascular dementia, 1214 with unspecified / other dementia) were matched to up to four controls by age, general practice and gender. We computed ORs and dose response effects for AD, vascular and unspecified / other dementia, comparing those prescribed ARBs or ACE-Is for at least 6 months with patients prescribed other anti-hypertensives. We controlled for matching factors, co-morbidities, smoking status, an area measure of socioeconomic status, consultation rate and blood pressure and accounted for reverse causality by introducing time-lags of up to 8 years prior to diagnosis / index date.Results Patients diagnosed with AD, vascular and unspecified / other dementia had fewer prescriptions for ARBs and ACE-Is. Inverse associations with AD were strongest for ARBs (OR 0.47, 95% CI 0.37 to 0.58) compared with ACE-Is (OR 0.76, 95% CI 0.69 to 0.84) (p difference <0.001). Associations of ARBs with AD were stronger than for vascular dementia (p difference=0.01) and unspecified / other dementia (p difference=0.23). There were inverse dose-response relationships between ARBs and ACE-Is with AD (both p trend <0.01). The inverse association of ACE-Is with AD diminished when using longer time lags but the ARB-AD association persisted.Conclusions Patients with AD were around half as likely to be prescribed ARBs. Further randomised controlled trial evidence is required to rigorously test these findings.