[Treatment of isolated systolic arterial hypertension and prevention of dementia in aged patients. The Syst-Eur multicenter study].
The aim of the vascular dementia project, set up in the framework of the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial, was to investigate the influence of antihypertensive drug treatment on the incidence of vascular dementia. The study was run on non-demented patients, at least 60 years old, with isolated systolic hypertension (sitting blood pressure of 160-219 mmHg for systolic and below 95 mmHg for diastolic). Treatment was initiated with nitrendipine (10-40 mg/day) possibly associated with enalapril (5-20 mg/day) and/or hydrochlorothiazide (12.5-25 mg/day). Cognitive function was assessed at baseline and annually by the Mini Mental State Examination (MMSE). The diagnosis of dementia was based on the DSM-III-R criteria. The etiology of dementia was established using the Modified Ischemic Score or the Hachinski score when brain imaging was not available. Median follow-up by intention-to-treat was 2.0 years. The incidence of dementia was reduced by 50% from 7.7 per 1000 patient-years in the placebo group (number of patients 1,180) to 3.7 cases per 1000 p-a in the active treatment group (n = 1,238) (21 vs 11 patients, p = 0.05). At the last available evaluation, systolic and diastolic blood pressure were 8.3 mmHg and 3.8 mm Hg lower (p < or = 0.001) in the active-treatment group, but on average the MMSE scores remained stable in both groups.


CONCLUSIONS
In older people with isolated systolic hypertension, antihypertensive treatment started with nitrendipine may reduce the incidence of dementia. At the rate observed in the placebo group, treating 1,000 patients for 5 years would prevent 19 cases of dementia.
Seux
M L
ML
Service de gérontologie clinique, hôpital Broca, Paris.
Staessen
J A
JA
Forette
F
F
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003704:Dementia / Q000453:epidemiology / Q000517:prevention & control*; D004311:Double-Blind Method; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D015994:Incidence; D008297:Male
D000959:Antihypertensive Agents