Effect of Discontinuation of Antihypertensive Treatment in Elderly

Study Questions:

Does discontinuation of antihypertensive treatment in older persons with mild cognitive deficits improve cognitive, psychological, and general daily functioning?

Methods:

A community-based randomized clinical trial with a blinded outcome assessment at the 16-week follow-up was performed in the Netherlands. A total of 385 participants 75 years or older with mild cognitive deficits (Mini-Mental State Examination score, 21-27) without serious cardiovascular disease who received antihypertensive treatment were enrolled in the DANTE (Discontinuation of Antihypertensive Treatment in Elderly People) Study Leiden from mid-2011 through mid-2013. Intention-to-treat analyses were performed from January 20 through April 11, 2014.

Results:

Compared with 176 participants undergoing analysis in the continuation group, 180 in the discontinuation group had a greater increase (95% confidence interval) in systolic blood pressure (difference, 7.36 [3.02-11.69] mm Hg; p = 0.001) and diastolic blood pressure (difference, 2.63 [0.34-4.93] mm Hg; p = 0.03). The discontinuation group did not differ from the continuation group in change in overall cognition compound score, or significantly in secondary outcomes, including differences in change in compound scores of the three cognitive domains (executive function, memory, and psychomotor speed), symptoms of apathy and depression, functional status, and quality-of-life score. Adverse events were equally distributed.

Conclusions:

In older persons with mild cognitive deficits, discontinuation of antihypertensive treatment did not improve cognitive, psychological, or general daily functioning at the 16-week follow-up.

Perspective:

There is no evidence in the elderly that antihypertensive treatment reduces the risk for dementia. And there is evidence of a ‘U’ shaped curve with increasing cardiovascular events attributable to low blood pressure in antihypertensive treatment trials, which has been thought related to impaired cerebral autoregulation that may contribute to cognitive decline.

Clinical Topics: Diabetes and Cardiometabolic Disease, Geriatric Cardiology, Prevention, Sleep Apnea

Keywords: Antihypertensive Agents, Blood Pressure, Cognition, Cognition Disorders, Dementia, Depression, Executive Function, Geriatrics, Homeostasis, Hypotension, Metabolic Syndrome X, Primary Prevention


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