Candesartan and cognitive decline in older patients with hypertension
Candesartan and cognitive decline in older patients with hypertension
复制标题
坎地沙坦与老年高血压患者认知能力下降
作者：
B. Saxby;F. Harrington;K. Wesnes;I. McKeith;Gary A. Ford
背景：高血压与认知功能受损有关，但降压治疗对认知功能的影响尚不清楚。方法：我们在参与老年人认知与预后研究的一中心开展了一项安慰剂对照、双盲、随机对照试验，研究血管紧张素受体阻滞剂坎地沙坦治疗高血压对认知的影响。共招募了257名老年高血压患者（平均年龄76岁，血压165±8/88±7 mm Hg），每日1次接受8-16 mg坎地沙坦或安慰剂治疗，平均随访期44个月。两组均允许额外的抗高血压治疗以达到治疗目标。认知功能是通过认知药物研究计算机化评估电池、追踪测试和语言流畅性来测量的。来自年度评估的数据被用于通过对五个认知领域的综合测试分数随时间的回归来计算单个下降系数。结果：研究结束时，两组之间的血压差异为8/3 mm Hg。与安慰剂相比，坎地沙坦组在注意力（0.004 vs - 0.036, p = 0.04）和情景记忆（0.14 vs - 0.22, p = 0.04）方面的下降幅度较小，在认知速度（- 2.3 vs - 17.4, p = 0.15）方面也有类似的趋势，但在工作记忆（0.0014 vs - 0.0010, p = 0.90）或执行功能（- 0.0031 vs - 0.0023, p = 0.95）方面没有差异。效应量在小到中等范围内。结论：血管紧张素受体阻滞剂的降压潜力可以降低老年高血压患者特定认知功能区域的下降速度，值得进一步研究以确定临床疗效。
Background: Hypertension is associated with impaired cognitive function but the effect of antihypertensive treatment on cognitive function is unclear. Methods: We investigated the effect of treatment of hypertension on cognition with the angiotensin-receptor-blocker, candesartan, in a placebo-controlled, double-blind, randomized controlled trial at one center participating in the Study on Cognition and Prognosis in the Elderly. A total of 257 older adults with hypertension (mean age 76 years, blood pressure 165 ± 8/88 ± 7 mm Hg) were recruited from general practice and treated with 8–16 mg candesartan or placebo once daily, for a mean follow-up period of 44 months. Additional antihypertensive therapy was permitted in both groups to achieve treatment targets. Cognitive function was measured using the Cognitive Drug Research computerized assessment battery, trail-making tests, and verbal fluency. Data from annual assessments were used to calculate individual coefficients of decline by regressing composite test scores over time for five cognitive domains. Results: The blood pressure difference between groups at study close was 8/3 mm Hg. The candesartan group showed less decline in attention (0.004 vs −0.036, p = 0.04) and episodic memory (0.14 vs −0.22, p = 0.04) compared to placebo, a similar trend for speed of cognition (−2.3 vs −17.4, p = 0.15), but no differences in working memory (0.0014 vs 0.0010, p = 0.90) or executive function (−0.0031 vs −0.0023, p = 0.95). Effect sizes were in the small-to-moderate range. Conclusions: The potential for blood pressure–lowering with angiotensin-receptor-blockers to reduce the rate of decline of specific areas of cognitive function in older patients with hypertension warrants further investigation to determine clinical efficacy.
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DOI：
10.1001/jama.1995.03530230032026
发表时间：
1995-12
期刊：
JAMA
影响因子：
--
作者：
L. Launer;K. Masaki;H. Petrovitch;D. Foley;R. Havlik
通讯作者：
L. Launer;K. Masaki;H. Petrovitch;D. Foley;R. Havlik
高血压的神经心理学相关性：回顾和方法学考虑。
影响因子：
22.4
作者：
Waldstein,SR;Manuck,SB;Ryan,CM;Muldoon,MF
通讯作者：
Muldoon,MF
影响因子：
5
作者：
ELIAS, MF;WOLF, PA;WHITE, LR
通讯作者：
WHITE, LR
影响因子：
8.3
作者：
Jennings, JR;Muldoon, MF;Manuck, SB
通讯作者：
Manuck, SB