It is good to read a research article on “Telmisartan use and risk of dementia in type 2 diabetes patients with hypertension: A population-based cohort study”.

Protective effect of Angiotensin receptor blockers (ARBs) against dementia occurrence in patients with hypertension (HTN) is a known fact, also mentioned by the authors of this cohort study.
The investigators of cohort study (of all patients registered in the Taiwan National Health Insurance Research Database) concluded that, telmisartan use in hypertensive T2DM patients may be associated with a lower risk of dementia and incidence of any ischemic stroke in an East-Asian population.

Similar evidence from the Taiwan National Health Insurance Research Database regarding the time- and dose-dependent protective effect of pioglitazone against dementia in diabetic patients, and also evidence that long term and high dose pioglitazone users had a lower risk of dementia than non-users [1].

Diabetes-associated cognitive dysfunction manifest as mild cognitive impairment (MCI) and dementia and mechanisms of MCI and dementia in T2DM involve mixed vascular and neurodegenerative pathologies [2].
The Framingham study reported that, untreated blood pressure levels are inversely related to cognitive functioning [3].
Merrill F. Elias et al., in a review study concluded that, cognitive dysfunction related to hypertension is a problem of patients of all age groups, not just a problem of old age [4].

This is revealed from the SPRINT Research Group study that, intensive blood pressure control did not significantly reduce the risk of probable dementia among ambulatory adults with hypertension [5].
A prospective cohort study of a general Japanese population demonstrated a significant independent association between high day-to-day blood pressure variability and the risk of developing all-cause dementia, vascular dementia, and Alzheimer's disease [6].

Type 2 diabetes mellitus (T2DM) and hypertension (HTN), both are potential risk factor to each other and aggravate the disease severity. Diabetes mellitus and hypertension, both diseases are associated with end organ/ target organ damage and cognitive impairment.

The combination of telmisartan and pioglitazone in patients with type 2 diabetes mellitus with hypertension would be a useful and rational combination in reducing the risk of cognitive impairment and dementia.

Regards,
Dr.Rajiv Kumar, Dr. Sangeeta Bhanwra.
Faculty, Department of Pharmacology, Government Medical College and Hospital Chandigarh-160030, India.

DRrajiv.08@gmail.com

References:
1. https://www.clinicalkey.c...

2. Biessels, G.J., Despa, F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications. Nat Rev Endocrinol 14, 591–604 (2018). https://doi.org/10.1038/s...

3. Mernll F. Elias, Philip A Wolf, Ralph B. D'Agostino, Janet Cobb, Lon R. White, Untreated Blood Pressure Level Is Inversely Related to Cognitive Functioning: The Framingham Study, American Journal of Epidemiology, Volume 138, Issue 6, 15 September 1993, Pages 353–364, https://doi.org/10.1093/o...

4. Elias MF, Goodell AL, Dore GA. Hypertension and cognitive functioning: a perspective in historical context. Hypertension. 2012 Aug; 60(2):260-8. https://www.ahajournals.o...

5. The SPRINT MIND Investigators for the SPRINT Research Group. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA. 2019;321(6):553–561. doi:10.1001/jama.2018.21442

6. https://www.ahajournals.o...