Treatment of hypertension in the elderly: II. Cognitive and behavioral function. Results of a Department of Veterans Affairs Cooperative Study.

Abstract

This study was designed to determine whether blood pressure reduction, per se, causes adverse effects on cognitive and behavioral function in elderly hypertensive patients. Men with mild-to-moderate diastolic hypertension who had passed their 60th birthday were entered into the trial. After a placebo washout period, they were assigned in a randomized, double-blind manner to one of two groups receiving hydrochlorothiazide (either 25 mg once or twice daily or 50 mg once or twice daily). Responders entered a 1-year maintenance period. Nonresponders were randomly assigned to double-blind treatment with hydralazine, methyldopa, metoprolol, or reserpine added to the diuretic therapy. During the placebo and treatment periods, patients underwent a battery of psychometric tests designed to assess cognitive function, motor skills, memory, and affect. A separate questionnaire assessed the patient's ability to perform activities of daily living. A subset of patients blindly being treated with placebo received the same battery of tests as a control for practice effect. The results showed that there was similar improvement on the psychometric tests between those patients whose blood pressure was successfully reduced and the placebo-treated control group. Therefore, the practice effect did not obscure a true deterioration in function. There were no substantive differences between the lower and higher doses of diuretic or among the four drugs added to the diuretic, although there were qualitative differences in side effects. We conclude that blood pressure reduction, per se, does not adversely affect cognitive and behavioral function in elderly hypertensive patients and that antihypertensive treatment is safe and effective in these patients. (Hypertension 1990;15:361-369) E levated blood pressure in elderly patients can be safely and effectively reduced by using either hydrochlorothiazide (HCTZ) alone or, if necessary, by the addition of hydralazine, methyldopa, metoprolol, or reserpine to HCTZ.1 This paper addresses the perception that such blood pressure reduction in elderly patients may be associated with uncomfortable or even disabling side effects. by drug therapy. As part of the study detailed in part I, 1 we performed extensive psychometric testing to determine objectively the effect of treatment on cognitive function, motor skills, and memory. In addition, we assessed changes in affective state and activities of daily living. MethodsThe details of the design for this multicenter trial are presented in part I.1 Briefly, 690 men who had passed their 60th birthday and who met entry criteria for mild-to-moderate hypertension were randomly assigned to treatment with HCTZ (from 25 to 100 mg/day). Patients who achieved goal blood pressure of less than 90 mm Hg and at least a 5 mm Hg decline from baseline entered a 6-month maintenance period. Patients who did not achieve goal blood pressure were randomly assigned to treatment with by guest on May 11, 2018 http://hyper.ahajournals.org/ Downloaded from

Effect of Long-Term Treatment with Antihypertensive Drugs on Quality of Life of Elderly Patients with Hypertension: A Double-Blind Comparative Study between a Calcium Antagonist and a Diuretic.

“…Different types of antihypertensive agent affect the elderly in a variety of ways (2, 7). Other studies, including the Systolic Hypertension in the Elderly Program (SHEP) (8), the Veterans Affairs Cooperative Study (9), and the Medical Research Council study (10), showed that diuretics (thiazide) did not adversely affect cognitive function or depression scale in the elderly. Subsequently there have been reports that angiotensin-converting enzyme (ACE) inhibitors and long-acting calcium antagonists have a beneficial effect on QOL in the elderly with hypertension (11,12).…”

Acute Confusional States in Older Adults and the Role of Polypharmacy

“…Hypotension, particularly the iatrogenic-induced syndrome, frequently has been cited as a cause of ACS in the elderly (28). Aggressive reduction of blood pressure in the elderly may cause decreased perfusion to the central nervous system and precipitate adverse effects on cognitive and behavioral function.…”

Bisoprolol in the treatment of hypertension in the elderly

“…It has been claimed that beta-blockers are less effective than diuretics. 2 However, Neutel et al 3 found in their study that two beta-blockers (atenolol, bisoprolol) have clearly different anti-hypertensive effects in patients over 65 years of age. Bisoprolol produced a greater reduction in BP than atenolol.…”