Effects of Angiotensin Converting Enzyme Inhibitors versus Angiotensin Receptor Blockers on Cognitive Decline: A Retrospective Real-World Database Study
1
Department of Internal Medicine,, Hackensack Meridian Health Ocean University Medical Center, United States
2
Department of Internal Medicine,, Ascension Saint Agnes Hospital, United States
3
Internal Medicine Department, University of Maryland Midtown Campus, United States
Submission date: 2025-10-15
Acceptance date: 2025-12-29
Publication date: 2026-04-30
Corresponding author
Laith Rhabneh
Department of Internal Medicine,, Hackensack Meridian Health Ocean University Medical Center, Brick, United States
Department of Internal Medicine,, Hackensack Meridian Health Ocean University Medical Center, Brick, United States
Wiadomości Lekarskie 2026;(4):736-744
KEYWORDS
TOPICS
ABSTRACT
Aim:
The purpose of this study was to compare 5-year cognitive outcomes in patients with HFrEF who receive angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).
Material and methods:
Retrospective cohort study of: 1) 135,873 adults with HFrEF (International Classification of Diseases-10th Revision-Clinical Modification [ICD-10-CM] codes: I50.2 or I50.4) started on ACEI between Aug 1, 2019 and Aug 1, 2024; and 2) 135,873 propensity matched patients receiving ARBs during that time. Data were obtained from the TriNetX Research Network, encompassing 80 health care organizations in the United States. The primary endpoint was the composite of cognitive decline (ICD-10-CM: R41.8), dementia (ICD-10-CM: F01-F03), and Alzheimer’s disease (ICD-10- CM: G30).
Results:
At 5 years,17,679 patients on ACEI met the primary endpoint vs 16,345 patients on ARBs (5-year incidence: 30.71% vs 28.54%; HR: 1.153; 95% CI: 129-1.178; P < 0.001), with consistently higher rates of cognitive decline (24.94% vs 22.81%; HR: 1.146; 95% CI: 1.119-1.174; P < 0.001), dementia (15.63% vs 13.71%; HR:1.204; 95% CI: 1.168-1.241; P < 0.001), and Alzheimer’s disease (4.15% vs 3.51%; HR: 1.202; 95% CI: 1.131-1.277; P < 0.001) in the ACEI cohort.
Conclusions:
ACEI was associated with higher 5-year rates of neurocognitive disorders when compared to ARBs in patients with HFrEF.
The purpose of this study was to compare 5-year cognitive outcomes in patients with HFrEF who receive angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).
Material and methods:
Retrospective cohort study of: 1) 135,873 adults with HFrEF (International Classification of Diseases-10th Revision-Clinical Modification [ICD-10-CM] codes: I50.2 or I50.4) started on ACEI between Aug 1, 2019 and Aug 1, 2024; and 2) 135,873 propensity matched patients receiving ARBs during that time. Data were obtained from the TriNetX Research Network, encompassing 80 health care organizations in the United States. The primary endpoint was the composite of cognitive decline (ICD-10-CM: R41.8), dementia (ICD-10-CM: F01-F03), and Alzheimer’s disease (ICD-10- CM: G30).
Results:
At 5 years,17,679 patients on ACEI met the primary endpoint vs 16,345 patients on ARBs (5-year incidence: 30.71% vs 28.54%; HR: 1.153; 95% CI: 129-1.178; P < 0.001), with consistently higher rates of cognitive decline (24.94% vs 22.81%; HR: 1.146; 95% CI: 1.119-1.174; P < 0.001), dementia (15.63% vs 13.71%; HR:1.204; 95% CI: 1.168-1.241; P < 0.001), and Alzheimer’s disease (4.15% vs 3.51%; HR: 1.202; 95% CI: 1.131-1.277; P < 0.001) in the ACEI cohort.
Conclusions:
ACEI was associated with higher 5-year rates of neurocognitive disorders when compared to ARBs in patients with HFrEF.
| eISSN: | 2719-342X |
| ISSN: | 0043-5147 |
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