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May 5, 2008

Candesartan and cognitive decline in older patients with hypertension
A substudy of the SCOPE trial

May 6, 2008 issue
70 (19_part_2) 1858-1866

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.

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Information & Authors

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Published In

Neurology®
Volume 70Number 19_part_2May 6, 2008
Pages: 1858-1866
PubMed: 18458219

Publication History

Published online: May 5, 2008
Published in print: May 6, 2008

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Authors

Affiliations & Disclosures

B. K. Saxby, BSc
From the Institute for Ageing and Health (B.K.S., F.H., I.G.M., G.A.F.), University of Newcastle, Newcastle upon Tyne; and Cognitive Drug Research Ltd. (B.K.S., K.A.W.), Goring-on-Thames, UK.
F. Harrington, MD
From the Institute for Ageing and Health (B.K.S., F.H., I.G.M., G.A.F.), University of Newcastle, Newcastle upon Tyne; and Cognitive Drug Research Ltd. (B.K.S., K.A.W.), Goring-on-Thames, UK.
K. A. Wesnes, PhD
From the Institute for Ageing and Health (B.K.S., F.H., I.G.M., G.A.F.), University of Newcastle, Newcastle upon Tyne; and Cognitive Drug Research Ltd. (B.K.S., K.A.W.), Goring-on-Thames, UK.
I. G. McKeith, MD
From the Institute for Ageing and Health (B.K.S., F.H., I.G.M., G.A.F.), University of Newcastle, Newcastle upon Tyne; and Cognitive Drug Research Ltd. (B.K.S., K.A.W.), Goring-on-Thames, UK.
G. A. Ford, MD
From the Institute for Ageing and Health (B.K.S., F.H., I.G.M., G.A.F.), University of Newcastle, Newcastle upon Tyne; and Cognitive Drug Research Ltd. (B.K.S., K.A.W.), Goring-on-Thames, UK.

Notes

Address correspondence and reprint requests to Professor Gary A. Ford, Clinical Research Centre, 4th Floor Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK, NE1 4LP [email protected].

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