Is the cognitive function of older patients affected by antihypertensive treatment? Results from 54 months of the Medical Research Council's treatment trial of hypertension in older adults

Abstract

Objective : To establish whether initiation of treatment with diuretic or β blocker is associated over 54 months with change in cognitive function. Design : A cognitive substudy, nested within a randomised, placebo controlled, single blind trial. Setting : 226 general practices from the Medical Research Council's general practice research framework. Subjects : A subset of 2584 subjects sequentially recruited from among the 4396 participants aged 65-74 in the trial of treatment of hypertension in older adults. The 4396 subjects were randomised to receive diuretic, β blocker, or placebo. Subjects had mean systolic pressures of 160-209 mm Hg and mean diastolic pressures <115 mm Hg during an eight week run in. Outcome measures : The rate of change in paired associate learning test (PALT) and trail making test part A (TMT) scores (administered at entry and at 1, 9, 21, and 54 months) over time. Results : There was no difference in the mean learning test coefficients (rate of change of score over time) between the three treatments: diuretic -0.31 (95% confidence interval -0.23 to -0.39), β blocker -0.33 (-0.25 to -0.41), placebo -0.30, (-0.24 to -0.36). There was also no difference in the mean trail making coefficients (rate of change in time taken to complete over time) between the three groups: diuretic -2.73 (95% confidence interval -3.57 to -1.88), β blocker -2.08 (-3.29 to -0.87), placebo -3.01, (-3.69 to -2.32). A less conservative protocol analysis confirmed this negative finding. Conclusion : Treating moderate hypertension in older people is unlikely to influence, for better or for worse, subsequent cognitive function. Key messages: Key messages Studies have shown that treating hypertension in older adults reduces cardiovascular mortality and morbidity Treating moderate hypertension with either diuretic or β blocker does not seem to influence cognitive function Concerns about damaging cognition should not deter doctors from treating hypertension in older patients Age should no longer be a factor in the decision to initiate antihypertensive treatment