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Background Angiotensin receptor blockers (ARB) may be associated with a lower risk of a clinical dementia diagnosis. This study investigated the association between ARB use during life and postmortem dementia neuropathology, compared with angiotensin-converting enzyme inhibitors (ACEI) use.Method Cases with documented ACEI (n=257) or ARB (n=102) use, regardless of dementia pathology, were selected from the UK Brain Banks Network dataset. Pathology was categorised as either ‘significant’ pathology (Thal amyloid phase >3, Braak neurofibrillary tangle stage >3, Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) score of moderate/high density and Lewy body (LB) Braak >0 or cortical/limbic/neocortical LB pathology) or ‘not significant’.Results The ARB group was less likely to have Alzheimer’s disease (AD) pathology compared with the ACEI group: Thal amyloid (adjusted OR (AOR) 0.59 (95% CI 0.36 to 0.97), p=0.038), Braak neurofibrillary tangle (AOR 0.61 (95% CI 0.38 to 0.98), p=0.041) and CERAD neuritic plaque (AOR 0.58 (95% CI 0.35 to 0.96), p=0.035). LB pathology did not differ significantly between ARB and ACEI groups, though use of either ACEI or ARB was associated with a lower likelihood of LB pathology (AOR 0.27 (95% CI 0.21 to 0.36), p<0.001).Conclusion ARB use is associated with a lower risk of AD pathology. The association between ARB/ACEI use and LB pathology requires further investigation.