[Effects of long-term antihypertensive therapy with losartan on blood pressure and cognitive function in patients with essential hypertension and other cerebrovascular risk factors (AWARE observational study)].
OBJECTIVE
As arterial hypertension is the most important risk factor for ischemic stroke, the relevant guidelines recommend rigorous treatment to normalize blood pressure. Hypertension can also be associated with cognitive decline and dementia. Therefore, the effect of a long-term therapy with the AT(1) antagonist losartan (+/- hydro chloro thiazide [HCTZ]) on cognitive function in patients with essential hypertension and additional cerebrovascular risk factors was investigated.


METHODS
Prospective, open observational study in 6,206 adult patients with known essential hypertension and cerebrovascular risk factors (most with a 10-year stroke risk of >or= 20% based on the Framingham Score). Demographic data, blood pressure, selected laboratory parameters, and cognitive function (c.I. test) were determined at baseline and after 3, 6, and 12 months.


RESULTS
The patients' mean age was 65.8+/-10.7 years and 46.1% of the patients were male. In addition to treatment with losartan +/- HCTZ, 54.1% of the patients received one or more additional antihypertensive agents. After 1 year of treatment, systolic/diastolic blood pressure fell from its baseline level of 158.1/90.3 mmHg to 137.3/80.6 mmHg (-20.8/-9.7 mmHg). The proportion of patients with no/mild/severe cognitive impairment was 30.0%/30.3%/39.7% at baseline and 34.8%/28.1%/37.1% at the end of the study. In patients with cognitive impairment, fibrinogen and hsCRP (high-sensitive C-reactive protein) levels were significantly elevated. Adverse events (AEs) were reported in 231 patients (3.7%), while serious/nonserious AEs possibly related to the study medication were reported in only six (0.1%) and 38 patients (0.6%), respectively.


CONCLUSIONS
A high proportion of patients with hypertension shows cognitive impairment; therefore, use of appropriate tests to detect this should be considered. The losartan-based antihypertensive treatment increased the proportion of patients with normal cognitive function, reduced blood pressure, and was well tolerated in the primary-care setting.
Schrader
Jürgen
J
St.-Josefs-Hospital, Cloppenburg. j.schrader@kh-clp.de
Lüders
Stephan
S
Diener
Hans-Christoph
HC
Haller
Hermann
H
Schmieder
Roland E
RE
Wahle
Klaus
K
Smolka
Wenefrieda
W
Jung
Claudia
C
Bestehorn
Kurt
K
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D002097:C-Reactive Protein / Q000378:metabolism; D002544:Cerebral Infarction / Q000517:prevention & control*; D003704:Dementia / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008134:Long-Term Care; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012307:Risk Factors
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D002097:C-Reactive Protein; D019808:Losartan