Antihypertensive Therapy and Cerebral Hemodynamics in Executive Mild Cognitive Impairment: Results of a Pilot Randomized Clinical Trial. Issue 2 (25th January 2013)

• Record Type: Journal Article
• Authors: Hajjar, Ihab; Hart, Meaghan; Chen, Yu‐Ling; Mack, Wendy; Novak, Vera; C. Chui, Helena; Lipsitz, Lewis
• Is Part Of: Journal of the American Geriatrics Society. Volume 61:Issue 2(2013:Feb.)
• Page Start: 194
• Page End: 201
• Publication Date: 2013-01-25
• Subjects: Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.12100
• Languages: English
• ISSNs: 0002-8614

Abstract

<abstract abstract-type="main" xml:lang="en" id="jgs12100-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jgs12100-sec-0001" sec-type="section"> <title>Objectives</title> <p>To compare the effects of three antihypertensive medications on cerebral hemodynamic and cognitive function in hypertensive individuals with executive dysfunction.</p> </sec> <sec id="jgs12100-sec-0002" sec-type="section"> <title>Design</title> <p>Double‐blind randomized clinical trial.</p> </sec> <sec id="jgs12100-sec-0003" sec-type="section"> <title>Setting</title> <p>Community.</p> </sec> <sec id="jgs12100-sec-0004" sec-type="section"> <title>Participants</title> <p>Fifty‐three individuals aged 60 and older with hypertension and executive dysfunction.</p> </sec> <sec id="jgs12100-sec-0005" sec-type="section"> <title>Intervention</title> <p>Lisinopril, candesartan, or hydrochlorothiazide for 1 year.</p> </sec> <sec id="jgs12100-sec-0006" sec-type="section"> <title>Measurements</title> <p>Cerebral blood flow velocity (BFV; transcranial Doppler ultrasonography during rest, sitting, standing, hypercapnia, and hypocapnia), cognition, and blood pressure were measured at baseline and after 6 and 12 months. Linear mixed models were used to compare the three groups.</p> </sec> <sec id="jgs12100-sec-0007" sec-type="section"> <title>Results</title> <p>Of the 53 participants, 47 had successful insonation (mean age 72; 70% white; 57% women). There was a tendency toward an increase in BFV in the candesartan group and a decrease in the lisinopril and hydrochlorothiazide groups (between‐group <italic>P</italic> = .57) that was significant in those with low BFV at baseline (<median 27.6 cm/s, between‐group <italic>P</italic> = .03). The candesartan group also had the greatest improvement in executive function (Trail Making Test Part B improved by 17.1 seconds, vs hydrochlorothiazide improved by 4.2 seconds and lisinopril worsened by 14.4 seconds, <italic>P</italic> = .008). Carbon dioxide vasoreactivity and vasomotor range declined significantly in the lisinopril (within‐group <italic>P</italic> = .001 for vasoreactivity and .02 for vasomotor range) and hydrochlorothiazide groups (within‐group <italic>P</italic> = .10 and .009, respectively) but not in the candesartan group (within‐group <italic>P</italic> = .25 and .38, respectively; between‐group <italic>P</italic> = .30 and .46, respectively).</p> </sec> <sec id="jgs12100-sec-0008" sec-type="section"> <title>Conclusion</title> <p>Angiotensin receptor blockers may preferentially preserve cerebral hemodynamics and executive function in individuals with executive dysfunction. These findings warrant further investigation in a larger trial.</p> </sec> </abstract>