Effects of Antihypertensive Therapy on Cognitive Decline in Alzheimer's Disease

BACKGROUND Therapeutic trials concerning the effect of anti hypertensive therapy on cognition have produced controversial findings. Our objective was to evaluate the impact of anti hypertensive therapy on the cognitive function in subjects already diagnosed with Alzheimer's disease (AD). METHODS We conducted an observational study in a memory clinic assessing outpatients suffering from AD. A total of 321 patients were included Cognitive function was assessed yearly by the Mini-Mental State Examination (MMSE; score/30). RESULTS The mean age of patients was 78.1 +/- 6 years, 54% of them received antihypertensive therapy and the mean MMSE scores were similar in both groups (patients taking anti hypertensive therapy and patient without antihypertensive therapy). The mean follow-up was 34.1 +/- 6 months. MMSE means were significantly higher among patients using anti hypertensive therapy compared to those without antihypertensive therapy (MMSE scores = 21.9 +/- 4.9 vs. 21.2 +/- 5.1 at 1 year (P = 0.001); 20.8 +/- 5.5 vs. 19.4 +/- 5.7 at 2 years (P<0.001); 19.0 +/- 6.7 vs. 17.5 +/- 6.4 at 3 years (P < 0.001)), after adjustment for age, gender, education level, systolic blood pressure (SBP), and diastolic blood pressure (DBP) at baseline, MMSE at baseline, coronary heart disease, statins, and antiplatelet agents' consumption. Furthermore, the use of antihypertensive therapy was associated with a lower estimated risk of cognitive decline (as defined by a decrease of at least one point in MMSE score over time) (hazard ratio = 0.61; 95% confidence interval = 0.45-0.81) after adjustment for the same factors. CONCLUSIONS These results suggest an association between anti hypertensive therapy, a lower decrease in mean MMSE and a lower cognitive decline over time in AD. Am J Hypertens 2009; 22:1020-1024 (C) 2009 American Journal of Hypertension, Ltd.