Friday, November 27, 2015         

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Beta blockers might fight dementia, UH-led study finds

By Melissa Healy

Los Angeles Times


Beta blockers, venerable blood-pressure drugs that have fallen from favor in recent years, may help protect the brain against changes linked to Alz­hei­mer's disease and other forms of dementia, new research led by a University of Hawaii neurologist indicates.

In autopsies on the brains of 774 men, scientists found that those who took beta blockers to help control hypertension had fewer of the brain lesions and less of the brain shrinkage seen in Alz­hei­mer's than men who took other types of blood-pressure medications and those who left the condition untreated. Their brains also showed significantly less evidence of multiple tiny strokes.

A parallel study showed that an expanded group of men who took beta blockers also experienced less cognitive decline as they aged compared with those in the control groups.

The research, to be presented at the American Academy of Neurology's annual meeting in March but released to the media on Monday, is preliminary. Of the 774 Japa­nese-American men who agreed to have their brains examined after death, 610 had high blood pressure, and only 40 had taken beta blockers.

That is far too small a number to support a conclusion that beta blockers have benefits beyond controlling high blood pressure, experts said.

If borne out by further research, the findings could give physicians a powerful tool for preventing dementia and induce many more Americans to get their blood pressure under control, said Dr. Charles DeCarli, director of the Alz­hei­mer's Disease Center at the University of California, Davis, who was not involved in the study.

The study adds to mounting evidence that high blood pressure has a corrosive and probably cumulative effect on the brain, and that treating it promptly and effectively can yield dividends beyond lowering the risk of heart attack or stroke. Studies suggest that the risk of Alz­hei­mer's and other dementia is lower for people whose blood pressure is kept within healthy bounds.

The newest study suggests that the 11 classes of drugs used to lower high blood pressure do not confer equal protection against dementia.

"Beta blockers are different," said Dr. Lon White, a UH neurologist who led the study, which has not yet been published in a medical journal.

In the U.S., 161 million prescriptions for beta blockers were filled in 2011, making them the sixth most commonly dispensed prescription drug in the United States, according to IMS Health. In addition to suppressing the rate at which the heart pumps blood, beta blockers can cause fatigue, impotence, depression and insomnia. As a result, they have lost ground to drugs with fewer side effects.

White suggested that by lowering the heart rate, beta blockers may reduce wear and tear on small blood vessels throughout the body, including those that carry oxygen and fuel to every corner of the brain. Fed by healthier vessels, the aging brain would be less likely to suffer tiny strokes called microinfarcts.

Because the loss of cells is small and scattered throughout the resilient brain, the toll on cognition may not be evident immediately, White said. But eventually the brain can be riddled with lesions, a condition called vascular dementia. And they may accelerate the early brain changes of Alz­hei­mer's, he said.

In microscopic examination of his subjects' brain tissues, White said, he found significantly fewer microinfarcts in those who had taken beta blockers.

"This is a tantalizing clue," he said.

DeCarli suggested another way in which healthier small blood vessels in the brain could help prevent or slow degenerative changes that come with Alz­hei­mer's: Vasculature may be key in clearing abnormal proteins from the brain, and where it has been damaged by the effects of hypertension, the tiny vessels may no longer be able to keep the stalking horses of Alz­hei­mer's from accumulating.

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