The association of antihypertensive agents with MRI white matter findings and with Modified Mini-Mental State Examination in older adults.
OBJECTIVE
To examine the association of antihypertensive regimen with magnetic resonance imaging (MRI) white matter hyperintensity and with cognitive impairment in older adults.


METHODS
Cross-sectional study.


METHODS
The Cardiovascular Health study, an observational prospective cohort study of risk factors for coronary heart disease and stroke in men and women 65 years of age and older.


METHODS
1268 men and women with pharmacologically treated hypertension.


METHODS
Information on medication use, medical history, and health habits was collected at clinic examinations. Participants completed the Modified Mini-Mental State Examination (3MS) and underwent MRI examination. Without clinical information, study neuroradiologists assigned an overall grade of white matter signal intensity on MRI on a scale from 0 (no findings) to 9 (extensive findings).


RESULTS
Adjusted mean white matter grade was higher for users of calcium channel blockers (2.59, P = .007) and users of loop diuretics (2.60, P = .015) than for users of beta blockers (2.12). The association was present for both dihydropyridine and non-dihydropyridine calcium channel blockers. Adjusted mean 3MS scores were lower for users of calcium channel blockers (89.6, P < .002), especially dihydropyridines, and users of loop diuretics (89.7, P < .006) than for users of beta blockers (92.3). No statistically significant association could be shown for users of other drug regimens, including thiazides and ACE inhibitors.


CONCLUSIONS
In this study, users of antihypertensive regimens which included calcium channel blockers or loop diuretics had more severe white matter hyperintensity on MRI and worse performance on 3MS than users of beta blockers.
Heckbert
S R
SR
Department of Epidemiology, University of Washington, Seattle, USA.
Longstreth
W T
WT
Psaty
B M
BM
Murros
K E
KE
Smith
N L
NL
Newman
A B
AB
Williamson
J D
JD
Bernick
C
C
Furberg
C D
CD
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects* / Q000473:pathology; D002121:Calcium Channel Blockers / Q000009:adverse effects; D003071:Cognition / Q000187:drug effects*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004232:Diuretics / Q000009:adverse effects; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics