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
References