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Objective To investigate whether angiotensin receptor blockers protect against Alzheimer’s disease and dementia or reduce the progression of both diseases.

Design Prospective cohort analysis.

Setting Administrative database of the US Veteran Affairs, 2002-6.

Population 819 491 predominantly male participants (98%) aged 65 or more with cardiovascular disease.

Main outcome measures Time to incident Alzheimer’s disease or dementia in three cohorts (angiotensin receptor blockers, lisinopril, and other cardiovascular drugs, the “cardiovascular comparator”) over a four year period (fiscal years 2003-6) using Cox proportional hazard models with adjustments for age, diabetes, stroke, and cardiovascular disease. Disease progression was the time to admission to a nursing home or death among participants with pre-existing Alzheimer’s disease or dementia.

Results Hazard rates for incident dementia in the …