The treatment of hypertension in older people and its effect on cognitive function

Prince, Martin R.

doi:10.1016/s0753-3322(97)81597-1

Cited by 26 publications

(13 citation statements)

References 26 publications

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“…Opposing evidence from ran- domised controlled trials also exists, and hence the concern for adverse effects on cognition may be groundless [35]. However, among the oldest subjects, who have already become physically inactive and may use multiple cardiovascular drugs, the risk of adverse drug effects is great.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Impairment among Elderly Coronary Heart Disease Patients

et al. 1999

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Background: Coronary heart disease (CHD) and decline in cognitive functioning and dementia are common problems in the elderly. Cardiovascular diseases (CVDs) are connected with vascular dementia, but less is known about cognitive functioning among elderly patients with CHD based on population studies. Objective: To describe the associations between CHD and cognitive impairment among the elderly. Population and Methods: Of the total population of the Lieto study (488 community-dwelling men and 708 women, ≥64 years old), the ambulatory patients with CHD (89 men and 73 women) and sex- and age-matched controls without any sign of CHD (178 men and 146 women) were selected to make up the study population. CHD was defined as the presence of angina pectoris or a past myocardial infarction. Cognitive assessment was based on the Mini-Mental State Examination (MMSE). Results: The total MMSE scores, the MMSE subtest scores and the overall test-based cognitive functioning did not differ between patients and controls. Among men, higher MMSE subscores in orientation and language were related to more severe chest pain. According to logistic regression analyses, the cognitive impairment of men was associated with high age, the use of cardiac glycosides and physical disability. Among women, cognitive impairment was associated with high age and the use of antipsychotics. Conclusion: In general, CHD has no independent association with cognitive impairment among the non-institutionalized community-living elderly. Among men, however, a complicated CHD may negatively affect cognitive functioning.

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Section: Discussionmentioning

confidence: 99%

Cognitive Impairment among Elderly Coronary Heart Disease Patients

et al. 1999

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“…Treatment of hypertension in the elderly caused no deleterious effects on cognition, mood, and quality of life [95,96,97,98]. On the contrary, Forette et al [92] confirmed that treatment of systolic hypertension with nitrendipine, a long-acting dihydropyridine calcium channel blocker, protects against dementia in older patients.…”

Section: Treatment Of Risk Factors and Cognitive Outcomesmentioning

confidence: 99%

Vascular Dementia Prevention: A Risk Factor Analysis

Román¹

2005

Cerebrovasc Dis

130

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Brain injury from ischemic or hemorrhagic cerebrovascular disease (CVD) produces decline in cognitive functions and vascular dementia (VaD). Likewise, CVD may cause VaD from hypoperfusion of susceptible brain areas. CVD may also worsen degenerative dementias such as Alzheimer’s disease. Significant advances have been made in the identification and control of risk factors for stroke and cardiovascular disease. The main risk factors for VaD include age, hypertension and absence of antihypertensive medication, diabetes, cigarette smoking, history of cardiovascular disease (coronary heart disease, congestive heart failure, peripheral vascular disease), atrial fibrillation, left ventricular hypertrophy, hyperhomocysteinemia, orthostatic hypotension, cardiac arrhythmias, hyperfibrinogenemia, and sleep apnea. Recently identified risk factors include chronic infection and elevation of C-reactive protein, particularly in patients with diabetes. Evidence from controlled clinical trials strongly suggests that control of vascular risk factors, in particular hypertension, could prevent the development of dementia.

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“…It has been argued that in several studies treatment was initiated too late in the patients' life to prevent cerebral damage, therefore no effect was seen on cognition [29]. Even though no clear evidence exists regarding a bene cial effect on cognitive function from blood pressure lowering, there is a possibility that certain antihypertensive agents have a speci c ability to prevent cognitive decline or even improve cognitive functionindependent of the effect on blood pressure.…”

Section: Economics Of Improved Cognition With Losartanmentioning

confidence: 99%

The Potential Economic Consequences of Cognitive Improvement with Losartan

Jönsson¹,

Gerth²,

Fastbom³

2002

Blood Pressure

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In a clinical trial, treatment of mild-moderate hypertensive patients with losartan (50 mg) increased Mini-Mental State Examination (MMSE) scores by 4 points from baseline over a 26-month period, compared with a 1-point increase in patients treated with hydrochlorothiazide (25 mg). This study explores the potential economic consequences of this improvement in cognitive function in a population of elderly hypertensive patients in Sweden. Resource use and MMSE data for 437 hypertensive, non-demented subjects aged 75 years and above, were taken from a population-based study in Sweden. MMSE scores were strongly related with costs of care due to higher utilization of home help and special living arrangements in patients with low scores. A 1-point difference in MMSE was associated with a difference in the annual cost of care of approximately 5700 Swedish kronor (SEK). Over 26 months, the potential cost savings from the 4-point improvement observed with losartan was estimated to be between 24700 and 43700 SEK. This can be compared with the acquisition cost of losartan; approximately 5700 SEK over the study period. Thus, an improvement in cognitive function of the magnitude documented in the study of losartan vs hydrochlorothiazide, may translate into economic benefits beyond those expected in terms of blood pressure control.

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The treatment of hypertension in older people and its effect on cognitive function

Cited by 26 publications

References 26 publications

Cognitive Impairment among Elderly Coronary Heart Disease Patients

Cognitive Impairment among Elderly Coronary Heart Disease Patients

Vascular Dementia Prevention: A Risk Factor Analysis

The Potential Economic Consequences of Cognitive Improvement with Losartan

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