International Journal of Hypertension / 2012 / Article / Tab 1

Review Article

The Association between Hypertension and Dementia in the Elderly

Table 1

Randomized controlled trials about antihypertensive treatments and dementia/cognitive decline.

Study settingParticipants and follow upTreatmentTestMain results

Systolic hypertension in Europe study (Syst- Eur) [5]2.418 systolic hypertensives; mean age 70 years, followup 3.9 yearsCCB (nitrendipine) with possible addition of ACE-I (enalapril), diuretic (hydrochlorothiazide), or both versus placeboMMSEMean difference in BP between treatment groups and the control was 7.0 mm Hg SBP and 3.2 mm Hg DBP. Rates of dementia for patients in the active treatment groups and the control groups were 3.3 and 7.4 cases per 1.000 patient-years (relative risk reduction: 55%), respectively. Significant.

The perindopril protection against recurrent stroke study (PROGRESS) [6]6.105 subjects with prior stroke or transient ischemic attack; mean age 64 years, followup 3.9 yearsACE-I (perindopril) with possible addition of diuretic (indapamide) versus placeboMMSEMean difference in BP between treatment groups and the control was 9.0 mm Hg SBP and 4.0 mm Hg DBP. Rates of cognitive decline for patients in the active treatment groups and the control groups were 11.0 and 9.1% (relative risk reduction: 19%), respectively. Significant.

Systolic hypertension in the elderly program (SHEP) [7]4.736 systolic hypertensives; mean age 72 years, followup 4.5 yearsDiuretic (chlorthalidone) with possible addition of β blocker (atenolol) or sympathetic nervous blocker (reserpine) versus placeboShort CAREMean difference in BP between treatment groups and the control was 12.0 mm Hg SBP and 4.0 mm Hg DBP. Rates of dementia incidence for patients in the active treatment groups and the control groups were 3.6 and 4.2 cases per 1.000 patient-years (relative risk reduction: 14%), respectively. Not significant.

Study on cognition and prognosis in the elderly (SCOPE) [8]4.964 hypertensives; SBP160-170/DBP 90–99 mm Hg; aged 70– 89, followup 3.97 yearsARB (candesartan) versus placebo; open-label antihypertensive drugs were added to both groupsMMSEMean difference in BP between treatment groups and the control was 3.2 mm Hg SBP and 1.6 mm Hg DBP. Rates of dementia incidence for patients in the active treatment groups and the control groups were 6.3 and 6.8 cases per 1.000 patient-years, respectively. Not Significant.

Hypertension in the very elderly trial cognitive function assessment (HYVET- COG) [9]3.336 hypertensives; SBP 160–200 and DBP < 110 mm Hg; age ≤80, followup 2.2 yearsDiuretic (indapamide) with possible addition of ACE-I (perindopril) versus placeboMMSEMean difference in BP between treatment groups and the control was 15 mm Hg SBP and 5.9 mm Hg DBP. Rates of dementia incidence for patients in the active treatment groups and the control groups were 33 and 38 cases per 1.000 patient-years (hazard ratio 0.86). respectively. Not significant.

BP: blood pressure, SBP: systolic blood pressure, DBP: diastolic blood pressure.

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