The role of ACE inhibitors and ARBs in preserving cognitive function via hypertension Management: A critical Update

Search strategy To ensure a comprehensive evaluation of the neuroprotective effects of angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) on cognitive function in hypertension management, we employed a systematic search strategy across PubMed, Google Scholar, and Google Patents. Our searches were conducted using keywords such as angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, cognitive impairment, dementia, Alzheimer’s disease, and neuroprotection, with the objective to include all relevant peer-reviewed articles, reviews, and patents published up to the date of the last search. On PubMed, we applied filters to include only human studies in English, focusing on those that discuss the impact of these drugs on cognitive outcomes. Google Scholar was utilized to broaden the scope beyond indexed journals, capturing grey literature and additional significant studies, with emphasis on comparative analyses between ARBs and ACEIs. In Google Patents, we sought to identify patented formulations and novel therapeutic strategies involving these medications, aiming at cognitive function preservation or improvement. [Display omitted] •ARBs and ACEIs link hypertension management with cognitive preservation.•Neuroprotective effects of ARBs and ACEIs address neuroinflammation.•Medications may regulate blood pressure and protect cognitive health.•Cognitive benefits of ARBs and ACEIs align with oxidative stress reduction.•Personalized strategies guided by genetic and biomarker predictors hold promise. Hypertension poses a significant risk to cognition-related disorders like dementia. As the global population ages, age-related neurological illnesses such as Alzheimer’s disease are becoming increasingly prevalent. The primary hypertension treatments, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors, exhibit neuroprotective properties. However, observational studies suggest that they may independently contribute to cognitive decline and dementia. Some of these medications have shown promise in reducing cognitive impairment and amyloid buildup in Alzheimer’s models. While direct comparisons between the two drug classes are limited, angiotensin receptor blockers have been associated with less brain shrinkage, lower dementia incidence, and slower cognitive decline compared to angiotensin-converting enzyme inhibitors. Both types of medications can influence cognition by passing the blood–brain