Relationship between antihypertensive drug therapy and cognitive function in elderly hypertensive patients with memory complaints.
OBJECTIVE
To evaluate the relationship between antihypertensive treatments and cognitive function in elderly hypertensive patients with memory complaints.


METHODS
The association between cognitive function and antihypertensive drug therapy was studied in 1241 hypertensive elderly patients with memory complaints attending a geriatric outpatient clinic. Cognitive function was assessed using the Mini Mental State Examination (MMSE) and validated neuropsychological tests (Cognitive Efficiency Profile; CEP). Patients were classified into four categories according to their cognitive status: normal cognitive function, mild cognitive impairment (MCI), Alzheimer's disease (AD) or vascular dementia (VaD).


RESULTS
In this population aged 78 +/- 8 years, with a mean blood pressure of 152 +/- 19/86 +/- 12 mmHg, antihypertensive treatment was prescribed for 57% of patients. After adjustment for age, sex and education, treated hypertensive patients had better cognitive function than untreated patients (MMSE score 23.9 +/- 5.6/30 versus 22.7 +/- 6.4/30, P < 0.001, CEP score 49.1 +/- 24.9/100 versus 45.4 +/- 23.7/100, P < 0.001). This association was observed independently of the cognitive status, both in normal, MCI, AD and VaD hypertensive patients. The odds ratio (OR) for AD was 0.58 [95% confidence interval (CI) 0.42-0.81] in treated compared with untreated hypertensive patients. In patients on antihypertensive therapy, higher cognitive function was observed in patients using calcium antagonists compared with those without calcium antagonists (CEP 52.9 +/- 24.6/100 versus 46.4 +/- 23.4/100, P < 0.001; OR for AD 0.67; 95% CI 0.45-0.99), independently of blood pressure level.


CONCLUSIONS
Antihypertensive therapy was associated with a lower risk of cognitive impairment and AD. In particular, the use of calcium antagonists was associated with a decreased risk of cognitive impairment and AD independently of the blood pressure level, suggesting a specific neuroprotective effect of these antihypertensive agents.
Hanon
Olivier
O
Université Paris-Descartes, Department of Geriatrics, Hôpital Broca, Paris, France. olivier.hanon@brc.ap-hop-paris.fr
Pequignot
Renaud
R
Seux
Marie Laure
ML
Lenoir
Hermine
H
Bune
Alexandra
A
Rigaud
Anne Sophie
AS
Forette
Françoise
F
Girerd
Xavier
X
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000517:prevention & control*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000150:complications / Q000517:prevention & control*; D015331:Cohort Studies; D015140:Dementia, Vascular / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000523:psychology*; D008297:Male; D008569:Memory Disorders / Q000150:complications; D009483:Neuropsychological Tests; D012720:Severity of Illness Index
D000959:Antihypertensive Agents