Findings and implications of the Study on COgnition and Prognosis in the Elderly (SCOPE) – A review

The Study on Cognition and Prognosis in the Elderly (SCOPE) assessed the effect of candesartan on cardiovascular and cognitive outcomes in elderly patients (aged 70-89 years) with mild to moderate hypertension. Patients were randomized to treatment with candesartan 8-16 mg daily (n = 2477) or placebo (n = 2460) and followed for 3.7 years on average. In agreement with the study protocol, other antihypertensive drugs were added if blood pressure remained 160 mHg systolic and/or 90 mmHg diastolic. Due to extensive add-on therapy, particularly in patients randomized to placebo, the between-treatment difference in blood pressure was only 3.2/1.6 mmHg. Nevertheless, the main analysis showed that non-fatal stroke was reduced by 28% (p = 0.04) in the candesartan group compared with the control group, and there was a non-significant 11% reduction in the primary endpoint, major cardiovascular events (p = 0.19). This review article presents different predefined and post hoc analyses made so far. Of particular interest are significant risk reductions with candesartan in major cardiovascular events (32%, p = 0.013), cardiovascular mortality (29%, p = 0.049) and total mortality (27%, p = 0.018) in patients who did not receive add-on therapy after randomization, and in whom the difference in blood pressure was 4.7/2.6 mmHg. Other analyses suggest positive effects of candesartan-based treatment on cognitive function, quality of life and new-onset diabetes. In conclusion, SCOPE strongly suggests that candesartan treatment reduces cardiovascular morbidity and mortality in old and very old patients with mild to moderate hypertension. Candesartan-based antihypertensive treatment may also have positive effects on cognitive function and quality of life.