Risks of dementia and stroke in patients with hypertension using telmisartan or other renin‑angiotensin system inhibitors

INTRODUCTION: The aim of this study was to investigate the cognitive and cerebrovascular outcomes of patients with hypertension (HTN) receiving various renin-angiotensin system (RAS) inhibitors. METHODS: We further categorized 39,665 patients with HTN receiving long-term RAS inhibitor therapy into (1) telmisartan, (2) non-telmisartan angiotensin receptor blocker (NT-ARB), and (3) angiotensin-converting enzyme inhibitor groups. The main outcomes were a diagnosis of all dementias and the occurrence of all strokes during follow-up. RESULTS: The telmisartan group had the lowest risk of all dementias (telmisartan vs NT-ARB: hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.60 to 1.01; telmisartan vs angiotensin-converting enzyme inhibitor: HR: 0.67; 95% CI: 0.48 to 0.94). The telmisartan group also had a lower risk of all strokes when compared to NT-ARB (HR: 0.78; 95% CI: 0.61 to 0.99) in the time-dependent cohort. DISCUSSION: Use of telmisartan may be associated with marginally lower risks of all dementias and strokes compared to other RAS inhibitors in patients with HTN. HIGHLIGHTS: Whether telmisartan is associated with a reduced risk of dementia compared to other RAS inhibitors in patients with HTN and varying blood sugar levels remains unclear. Our cohort study aimed to investigate the long-term cognitive and cerebrovascular outcomes of hypertensive patients receiving telmisartan compared to those receiving other RAS inhibitors. Eligible individuals were categorized into three groups. Use of telmisartan may be associated with marginally lower risks of all dementia and stroke compared with other RAS inhibitors in patients with HTN.