ReviewCureus2025
Comparative Risk Assessment in Hypertensive Patients With Metabolic Syndrome by Exploring Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Recent developments and challenges in hypertensive dementia over the past year.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Cognitive impairment is a common clinical complication in patients with hypertension and metabolic syndrome. Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) are common antihypertensive agents popularly used, but their relative effects on cognitive outcomes are ambiguous. The aim of this study was to compare the effect of ARB versus ACEI on cognitive decline in hypertensive patients with or at risk of metabolic syndrome. We performed a systematic review and meta-analysis based on the PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, Scopus, and Web of Science up to April 2025. The review included studies with adults ≥50 years and trials comparing ARBs vs ACEIs, with the results involving cognitive outcomes. Studies of both cohorts and randomized controlled trials (RCTs) were eligible. Bias risk was analyzed using the Newcastle-Ottawa scale (version 2011) and Cochrane RoB 2.0. Random-effects meta-analysis was performed, and evidence was graded using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Ten studies (six cohort studies, three prospective studies, one RCT) with over 6.5 million participants were included. Cognitive outcomes included mild cognitive impairment, dementia, and amyloid accumulation. ARBs were associated with an 11% lower risk of cognitive decline compared to ACEIs (HR: 0.89; 95% CI: 0.80-0.98; I² = 0%). Subgroup analysis showed that there were stronger effects for cognitive versus cardiovascular outcomes. Blood-brain barrier-penetrant ARBs provided additional benefits, particularly in APOE ε4 carriers. The overall certainty of evidence was moderate. In hypertensive patients, especially those meeting the criteria for metabolic syndrome, ARBs were linked with stronger cognitive protection than ACEIs. These observations encourage ARB use in those who were susceptible to cognitive decline, but additional trials are needed for confirmation.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.