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May 06, 2008; 70 (19 Part 2) Articles

Candesartan and cognitive decline in older patients with hypertension

A substudy of the SCOPE trial

B. K. Saxby, F. Harrington, K. A. Wesnes, I. G. McKeith, G. A. Ford
First published May 5, 2008, DOI: https://doi.org/10.1212/01.wnl.0000311447.85948.78
B. K. Saxby
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F. Harrington
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K. A. Wesnes
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I. G. McKeith
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G. A. Ford
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Citation
Candesartan and cognitive decline in older patients with hypertension
A substudy of the SCOPE trial
B. K. Saxby, F. Harrington, K. A. Wesnes, I. G. McKeith, G. A. Ford
Neurology May 2008, 70 (19 Part 2) 1858-1866; DOI: 10.1212/01.wnl.0000311447.85948.78

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Abstract

Background: Hypertension is associated with impaired cognitive function but the effect of antihypertensive treatment on cognitive function is unclear.

Methods: We investigated the effect of treatment of hypertension on cognition with the angiotensin-receptor-blocker, candesartan, in a placebo-controlled, double-blind, randomized controlled trial at one center participating in the Study on Cognition and Prognosis in the Elderly. A total of 257 older adults with hypertension (mean age 76 years, blood pressure 165 ± 8/88 ± 7 mm Hg) were recruited from general practice and treated with 8–16 mg candesartan or placebo once daily, for a mean follow-up period of 44 months. Additional antihypertensive therapy was permitted in both groups to achieve treatment targets. Cognitive function was measured using the Cognitive Drug Research computerized assessment battery, trail-making tests, and verbal fluency. Data from annual assessments were used to calculate individual coefficients of decline by regressing composite test scores over time for five cognitive domains.

Results: The blood pressure difference between groups at study close was 8/3 mm Hg. The candesartan group showed less decline in attention (0.004 vs −0.036, p = 0.04) and episodic memory (0.14 vs −0.22, p = 0.04) compared to placebo, a similar trend for speed of cognition (−2.3 vs −17.4, p = 0.15), but no differences in working memory (0.0014 vs 0.0010, p = 0.90) or executive function (−0.0031 vs −0.0023, p = 0.95). Effect sizes were in the small-to-moderate range.

Conclusions: The potential for blood pressure–lowering with angiotensin-receptor-blockers to reduce the rate of decline of specific areas of cognitive function in older patients with hypertension warrants further investigation to determine clinical efficacy.

Glossary

ARB=
angiotensin-receptor-blocker;
BHS=
British Hypertension Society;
BP=
blood pressure;
CDR=
Cognitive Drug Research;
DBP=
diastolic BP;
HCTZ=
hydrochlorothiazide;
MMSE=
Mini-Mental State Examination;
NART=
New Adult Reading Test;
SBP=
systolic BP;
SCOPE=
Study on Cognition and Prognosis in the Elderly;
SHEP=
Systolic Hypertension in the Elderly Program;
Syst-Eur=
Systolic Hypertension in Europe.
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