ACE inhibitor use was associated with AD diagnosis only in the presence of an E4 allele.

[Rshircliff]

"ACE inhibitor use was associated with AD diagnosis only in the presence of an E4 allele."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873370/

Here I go again playing doctor Arghhhh need to find a new BP medication for mild hypertension. Untreated BP is usually around 145-150/70-85.

[marthaNH]

Well, that's bad news for me, if the study amounts to much. But is there another medication that is known to be better for us, or just a long list of drugs with no similar studies? I hate to switch to something new when a tiny dose of ACE inhibitor does the job for me, but if there's a clearly better drug....?

[ApropoE4]

Well, this goma mugicha from suntori apparently performs amazingly well:



But of course it hasn't been evaluated on e4s.

http://www.gomamugicha.com/

[KatieS]

R & Martha, as a fellow hypertensive, I've considered switching to an ACE blocker, losartan (Cozaar) over my diuretic. Evidence prior to your 2014 citation pointed to the possible dementia protective effects of both drugs: http://www.ncbi.nlm.nih.gov/pubmed/14996614
Autopsy results from ACE blockers looks promising:
http://www.ncbi.nlm.nih.gov/pubmed/22964777

[Stavia]

Read the whole study. It asks more questions than than the title suggests. Not enough to chuck away your ACEI. Its a cross sectional observation in a small group - a subgroup analysis of a study never designed to assess ACEIs in the first place.

[marthaNH]

Thanks for your read on it, Stavia.

[Rshircliff]

Thanks Stavia. I really value your input. It's hard to know, in the whole scheme of things, whether a study holds its weight or not. I often feel like a pendulum swing too far one way, then too far the other way. Balance...that is my goal.

[Stavia]

Rs : me too honey. Balance.
And together we are much more stable and are less likely to fall down a dead end rabbit hole.
We need to keep talking and caring about each other.

[Tincup]

"
need to find a new BP medication for mild hypertension. Untreated BP is usually around 145-150/70-85.

May want to read Moore's book [url] Moore is an MD PhD biophysicist researcher. He attacks hypertension from a potassium/sodium balance issue. Two main points: a) high insulin levels (i.e. insulin resistance) signals the kidney to conserve sodium & b) a potassium/sodium ratio of 4:1 or greater on dietary intake will signal the kidney to excrete sodium. He noted that fasting usually normalized blood pressure in a couple of days - because of the dramatically lower insulin levels. The latest advice from the low carb "gurus" is to actually supplement with sodium (along with potassium & magnesium) during an Atkins like "induction" (20g carbs)/day because a lot of the symptoms of "low carb flu" are from the body dumping sodium (from the lowered insulin).

[Stavia]

This has been considered in the medical community as well, George. Thanks for linking.
Hypertension is tricky. A mildly elevated level is usually not an issue in terms of absolute risk for the average person, but we are not average. I wouldnt normally fuss about a level like Rs's in midlife and wouldnt medicate unless there were other risk factors, but apoe4 is a risk and hypertension correlates with AD probably due to small vessel damage. For us IMO the risk benefit lies on the side of getting it down. I dont think there are guidelines to a level, but Id personally chose the stricter target of 120 systolic that we use for kidney protection in higher risk people.