Effects of blood pressure and lipid lowering on cognition
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Discussion
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Implication
Randomized double-blind trial finds blood pressure and lipid lowering do not reduce cognitive decline in older adults, indicating these therapies do not prevent age-related mental decline.
Key Points
- To assess whether long-term blood pressure lowering, lipid lowering, or combination therapy slows cognitive decline in older individuals at intermediate cardiovascular risk.
- Double-blind, randomized, placebo-controlled 2 × 2 factorial trial (HOPE-3, NCT00468923) conducted across 228 centers in 21 countries.
- Participants aged ≥70 years without known cardiovascular disease (N=2,361; 1,626 completed both assessments) were randomized to candesartan (16 mg) plus hydrochlorothiazide (12.5 mg) or placebo, and to rosuvastatin (10 mg) or placebo, with a median follow-up of 5.7 years.
- Cognitive function was assessed at baseline and study end using the Digit Symbol Substitution Test (DSST), modified Montreal Cognitive Assessment, and Trail Making Test Part B.
- Candesartan/hydrochlorothiazide reduced systolic blood pressure by 6.0 mm Hg, and rosuvastatin reduced LDL cholesterol by 24.8 mg/dL compared with placebo.
- Mean difference in DSST score change was -0.91 (95% CI -2.25 to 0.42) for candesartan/hydrochlorothiazide vs placebo, -0.54 (95% CI -1.88 to 0.80) for rosuvastatin vs placebo, and -1.43 (95% CI -3.37 to 0.50) for combination therapy vs double placebo.
- No statistically significant differences between active interventions and placebo were detected on any cognitive assessment measures.
Cite This Study
Bosch et al. (2019) studied this question.