Hostname: page-component-7dd5485656-zlgnt Total loading time: 0 Render date: 2025-10-31T08:57:02.103Z Has data issue: false hasContentIssue false
  • English
  • Français

Effects of different antihypertensive medication groups on cognitive function in older patients: A systematic review

Published online by Cambridge University Press:  23 March 2020

M. Stuhec ,
J. Keuschler ,
J. Serra-Mestres  and
M. Isetta
M. Stuhec*
Affiliation:
Department for clinical pharmacy, Ormoz psychiatric hospital, Ormoz, Slovenia Faculty of pharmacy, University of Ljubljana, Ljubljana, Slovenia
J. Keuschler
Affiliation:
Faculty of pharmacy, University of Ljubljana, Ljubljana, Slovenia
J. Serra-Mestres
Affiliation:
Central and North West London NHS Foundation Trust, London, UK
M. Isetta
Affiliation:
Central and North West London NHS Foundation Trust, London, UK
*
*Corresponding author at: Faculty of pharmacy, University of Ljubljana, Ljubljana, Slovenia. E-mail address:matejstuhec@gmail.com (M. Stuhec).
Get access

Abstract

Background:

Chronic hypertension has been associated with an increased risk of cognitive decline. Although a link between hypertension and cognitive decline has been established, there is less evidence supported by systematic reviews. The main aim was to compare different antihypertensive drug groups in relation to their effect on cognition in older patients without established dementia using a systematic review.

Method:

A systematic search in Medline and Embase through to January 2017 was used to identify randomized controlled clinical trials (RCTs) studying the impact of different antihypertensives on cognition in older patients without dementia. Angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-Is), beta-blockers (BBs), diuretics, and calcium channel blockers (CCBs) were included in this review.

Results:

The systematic search identified 358 studies. The full text of 31 RCTs was reviewed and a total of 15 RCTs were included in the review. Most studies reported an improvement in episodic memory in patients treated with ARBs versus placebo or other types of antihypertensive drugs. No study showed an improvement in cognition in patients who received diuretics, BBs, or CCBs. Heterogeneity was high in most trials (predominantly in the blinding of participants and investigators).

Conclusion:

This review suggests that ARBs can improve cognitive functions in the elderly, especially episodic memory. ACE-Is, diuretics, BBs and CCBs did not seem to improve cognitive function in the elderly but were similarly effective in blood pressure lowering as ARBs.

Keywords

Geriatric psychiatry and agingNeurologyPsychopharmacologyNeuroscienceCognition

Information

Type
Review
Information
European Psychiatry , Volume 46 , October 2017 , pp. 1 - 15
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Rouch, LCestac, PHanon, OCool, CHelmer, CBouhanick, B, et al.Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs 2015;29:113–130.CrossRefGoogle ScholarPubMed
Levi Marpillat, NMacquin-Mavier, ITropeano, AIBachoud-Levi, ACMaison, PAntihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 2013;31:1073–1082.10.1097/HJH.0b013e3283603f53CrossRefGoogle ScholarPubMed
Birns, JMorris, RDonaldson, NKalra, LThe effects of blood pressure reduction on cognitive function: a review of effects based on pooled data from clinical trials. J Hypertens 2006;24:1907–1914.10.1097/01.hjh.0000244934.81180.16CrossRefGoogle ScholarPubMed
McGuinness, BTodd, SPassmore, PBullock, RBlood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev 2009;4:CD004034.Google Scholar
McGuinness, BTodd, SPassmore, PBullock, RThe effects of blood pressure lowering on development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease. Cochrane Database Syst Rev 2006;19:CD004034.Google Scholar
Shamseer, LMoher, DClarke, MGhersi, DLiberati, APetticrew, M, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 elaboration and explanation. BMJ 2015;349:g7647.CrossRefGoogle Scholar
Higgins, JPTAltman, DGStearne, JACAssessing risk of bias in included studies. In: Higgins, JPTGreen, S, editors. Cochrane handbook for systematic reviews of interventions version 5. 1. 0 (updated March 2011) The Cochrane Collaboration; 2011 [Accessed, March 2017], http://www.cochrane-handbook.org.Google Scholar
Hajjar, IHart, MChen, YLMack, WNovak, VChui, CH, et al.Antihypertensive therapy and cerebral hemodynamics in executive mild cognitive impairment: results of a pilot randomized clinical trial. J Am Geriatr Soc 2013;61:194–201.CrossRefGoogle ScholarPubMed
Anderson, CTeo, KGao, PArima, HDans, AUnger, T, et al.Renin-angiotensin system blockade and cognitive function in patients at high risk of cardiovascular disease: analysis of data from the ONTARGET and TRANSCEND studies. Lancet Neurol 2011;10:43–53.CrossRefGoogle ScholarPubMed
Skinner, MHFutterman, AMorrissette, DThompson, LWHoffman, BBBlaschke, TFAtenolol compared with nifedipine: effect on cognitive function and mood in elderly hypertensive patients. Ann Intern Med 1992;116:615–623.10.7326/0003-4819-116-8-615CrossRefGoogle ScholarPubMed
Peters, RBeckett, NForette, FTuomilehto, JClarke, RRitchie, C, et al.Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol 2008;7(8): 683–689.CrossRefGoogle ScholarPubMed
Sato, NSaijo, YSasagawa, YMorimoto, HTakeuchi, TSano, H, et al.Combination of antihypertensive therapy in the elderly, multicenter investigation (CAMUI) trial: results after 1 year. J Hypertens 2013;31:1245–1255.CrossRefGoogle Scholar
Fogari, RMugellini, AZoppi, ALazzari, PDestro, MRinaldi, A, et al.Effect of telmisartan/hydrochlorothiazide vs. lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J Hum Hypertens 2006;20:177–185.10.1038/sj.jhh.1001964CrossRefGoogle ScholarPubMed
Fogari, RMugellini, AZoppi, AMarasi, GPasotti, CPoletti, L, et al.Effects of valsartan compared with enalapril on blood pressure and cognitive function in elderly patients with essential hypertension. Eur J Clin Pharmacol 2004;59:863–868.CrossRefGoogle ScholarPubMed
Saxby, BKHarrington, FWesnes, KAMcKeith, IGFord, GACandesartan and cognitive decline in older patients with hypertension: a substudy of the SCOPE trial. Neurology 2008;70:1858–1866.10.1212/01.wnl.0000311447.85948.78CrossRefGoogle ScholarPubMed
Katada, EUematsu, NTakuma, YMatsukawa, NComparison of effects of valsartan and amlodipine on cognitive functions and auditory p300 event-related potentials in elderly hypertensive patients. Clin Neuropharmacol 2014;37:129–132.CrossRefGoogle ScholarPubMed
Fogari, RMugellini, AZoppi, ADerosa, GPasotti, CFogari, E, et al.Influence of losartan and atenolol on memory function in very elderly hypertensive patients. J Hum Hypertens 2003;17:781–785.10.1038/sj.jhh.1001613CrossRefGoogle ScholarPubMed
Prince, MJBird, ASBlizard, RAMann, AHIs the cognitive function of older patients affected by antihypertensive treatment? Results from 54 months of the Medical Research Council's trial of hypertension in older adults. BMJ 1996;312(7034): 801–805.CrossRefGoogle ScholarPubMed
Gurland, BJTeresi, JSmith, WMBlack, DHughes, GEdlavitch, SEffects of treatment for isolated systolic hypertension on cognitive status and depression in the elderly. J Am Geriatr Soc 1988;36:1015–1022.CrossRefGoogle ScholarPubMed
Starr, JMWhalley, LJDifferential cognitive outcomes in the Hypertensive Old People in Edinburgh study. J Neurol Sci 2005;229–230:10–107.Google ScholarPubMed
Hearing, SDWesnes, KBowman, CEBeta blockers and cognitive function in elderly hypertensive patients: withdrawal and consequences of ACE inhibitor substitution. Int J Geriatr Psychiatry 1999;2:13–17.Google Scholar
Hanyu, HHirao, KShimizu, SIwamoto, TKoizumi, KAbe, KFavourable effects of nilvadipine on cognitive function and regional cerebral blood flow on SPECT in hypertensive patients with mild cognitive impairment. Nucl Med Commun 2007;28:281–287.CrossRefGoogle ScholarPubMed
Yasar, SXia, JYao, WFurberg, CDXue, QLMercado, CIAntihypertensive drugs decrease risk of Alzheimer disease: Ginkgo Evaluation of Memory Study. Neurology 2013;81:896–903.CrossRefGoogle ScholarPubMed
Sorbi, SHort, JErkinjuntti, TFladby, TGainotti, GGurvit, H, et al.EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol 2012;19:1159–1179.CrossRefGoogle Scholar
Mancia, GFagard, RNarkiewicz, KRedón, JZanchetti, ABöhm, M, et al.2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281–1357.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.