title: Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of the Observational Study on Cognitive Function and SBP Reduction (OSCAR) study.
abstract: The Observational Study on Cognitive Function and SBP Reduction (OSCAR) provided opportunities to examine the influence of eprosartan on trends in cognitive performance in a large population of patients with difficult-to-treat hypertension (DTTH). A total of 4649 patients diagnosed retrospectively with DTTH, defined as systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mm Hg despite use of at least 3 antihypertensive drugs during the month preceding the baseline visit comprised the intention-to-treat (ITT) cohort. The patients were given eprosartan-based antihypertension therapy (EBT; 600 mg/d). Blood pressure and cognitive function parameters included significant (P<.001) differences for DTTH vs non-DTTH patients such as older age, body mass index, SBP and pulse pressure (PP), and lower Mini-Mental State Examination (MMSE) score. After EBT for 6 months, SBP/DBP in DTTH was 138.8±12.2/81.9±7.4 (ΔSBP-26±15.7; ΔDBP-11.4±9.8); PP was 57.0±10.8 (ΔPP-14.5±13.8) (all P<.001 vs baseline and non-DTTH group). A total of 2576 patients (87.4%) responded to EBT (ie, SBP <140 mm Hg and/or ΔSBP ≥15 mm Hg, or DBP <90 mm Hg and/or ΔDBP ≥10 mm Hg); 1426 DTTH patients (48.4%) achieved normalized SBP/DBP (ie, SBP <140 mm Hg and DBP <90 mm Hg). ΔPP in DTTH-isolated systolic hypertension (ISH) was -18.0±13.3 mm Hg (P=.003 vs DTTH-systolic-diastolic hypertension). End-of-EBT mean MMSE was 27.5±3.0 (P<.001 vs baseline). Blood pressure responses after EBT coincided with stabilization/improvement of MMSE in this retrospective investigation in DTTH patients. The average improvement in MMSE in DTTH patients was similar to that in non-DTTH patients. EBT effects on PP may be relevant to the evolution of MMSE in DTTH-ISH patients.
authors.affiliation: From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1 the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2 Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3 Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France 5.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Petrella
authors.affiliation: From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1 the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2 Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3 Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France 5.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Shlyakhto
authors.affiliation: From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1 the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2 Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3 Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France 5.
authors.forename: Alexandra O
authors.initials: AO
authors.lastname: Konradi
authors.affiliation: From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1 the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2 Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3 Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France 5.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Berrou
authors.affiliation: From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1 the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2 Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3 Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France 5.
authors.forename: Armand
authors.initials: A
authors.lastname: Sedefdjian
authors.affiliation: From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1 the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2 Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3 Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France 5.
authors.forename: Atul
authors.initials: A
authors.lastname: Pathak
authors.affiliation: From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1 the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2 Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3 Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France 5.
mesh_terms: D000179:Acrylates / Q000494:pharmacology* / Q000627:therapeutic use; D000368:Aged; D057912:Angiotensin II Type 2 Receptor Blockers / Q000494:pharmacology* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007093:Imidazoles / Q000494:pharmacology* / Q000627:therapeutic use; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013876:Thiophenes / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D000179:Acrylates; D057912:Angiotensin II Type 2 Receptor Blockers; D000959:Antihypertensive Agents; D007093:Imidazoles; D013876:Thiophenes; C068373:eprosartan