Does Discontinuing Antihypertensive Therapy in Older Patients Improve Cognitive Functioning?

The discontinuation of antihypertensive therapy in older patients with mild cognitive deficits did not improve short-term cognitive, psychological or general daily functioning, according to a study published Aug. 24 in JAMA Internal Medicine.

The DANTE study looked at 385 participants ages 75 or older with mild cognitive deficits and without serious cardiovascular disease who received antihypertensive treatment at 128 general medical practices. Participants were nearly equally divided into two groups: discontinuation of antihypertensive therapy (n=199) vs. continuation of antihypertensive therapy (n=186).

Results showed that after 16-week follow-up, the intervention group where antihypertensive therapy was discontinued did not differ from the control group where antihypertensive therapy was continued in overall cognition compound score. The two groups also did not differ in terms of changes for three cognitive domains – executive function, memory and psychomotor speed – as well as symptoms of apathy and depression, functional status and quality of life.

The authors conclude that moving forward, "future randomized clinical trials with longer follow-up should determine whether older persons with impaired cerebral autoregulation might benefit from less stringent blood pressure targets."

In a corresponding editorial comment, Michelle C. Odden, PhD, notes "we have made great strides in building the evidence base for initiating and intensifying antihypertensive therapy, but we have neglected to study the effects of continuing and discontinuing therapy in older adults. This study is the first step forward in answering these important scientific questions."

Meanwhile, a separate research letter also published in JAMA Internal Medicine by Michael E. Johansen, MD, MS, and Lee A. Green, MD, MPH, looked at the use of statins in the elderly, and found that "the very elderly have the highest rate of statin use in the U.S."

They note that there is little randomized evidence to guide the use of statins in patients older than 79 years. "Although the medical community has embraced the use of statins for primary prevention in the very elderly, caution should be exercised given the potential dangers of expanding marginally effective treatments to untested populations," they conclude.

Clinical Topics: Dyslipidemia, Geriatric Cardiology, Prevention, Nonstatins, Novel Agents, Statins, Sleep Apnea

Keywords: Aged, Antihypertensive Agents, Apathy, Blood Pressure, Cognition, Control Groups, Depression, Executive Function, Homeostasis, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Memory, Primary Prevention, Quality of Life

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