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Clinical Summary

Does the use of cardiovascular medication prevent cognitive decline?

Takeaway

  • Long-term blood pressure (BP) treatment with candesartan/hydrochlorothiazide, lipid lowering with rosuvastatin and their combination did not affect cognitive or functional decline in older people (age, ≥70 years) at intermediate risk of cardiovascular disease (CVD).

Why this matters

  • Elevated BP in midlife increases the risk for later-life development of cognitive impairment; however, there is no clarity at present whether lowering BP can prevent cognitive decline.

Study design

  • HOPE-3 study randomly assigned participants without known CVD to receive candesartan/hydrochlorothiazide (16 mg/12.5 mg) or placebo and rosuvastatin 10 mg or placebo.
  • Cognitive assessment such as Digit Symbol Substitution Test (DSST, cognitive decline defined as decrease of ≥5 points) was performed for 2361 participants (mean age, 74.1 years; 59% women; 45% had hypertension) from 21 countries.
  • Median Follow-up period: 5.7 years.
  • Funding: Canadian Institutes of Health Research and AstraZeneca.

Key results

  • Mean difference in systolic BP reduction between candesartan/hydrochlorothiazide and placebo was 6.0 mmHg, and the mean reduction in low-density lipoprotein cholesterol between rosuvastatin and placebo was 24.8 mg/dL.
  • Overall mean decline in DSST scores was 5.4 from baseline.
  • No significant differences in DSST scores were observed between:
    • candesartan/hydrochlorothiazide and placebo (difference in adjusted means, −0.91; 95% CI, −2.25 to 0.42);
    • rosuvastatin and placebo (−0.54; 95% CI, −1.88 to 0.80) and
    • candesartan+hydrochlorothiazide+rosuvastatin and double placebo (−1.43; 95% CI, −3.37 to 0.50).

Limitations

  • Selection bias.

References


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