Key result
Candesartan improves executive function more than lisinopril or HCTZ in hypertensive older adults.
Why the study?
Approximately 50% of older hypertensive individuals have executive dysfunction, which is linked to high dementia risk, but no therapeutic options have been studied for this condition.
Does an ARB-based regimen (candesartan) improve executive function in older hypertensive adults with early executive cognitive impairment compared to other antihypertensive regimens?
RCT (n=53)
Double-blind
Computer generated random allocation sequence
No
Does an ARB-based regimen (candesartan) improve executive function in older hypertensive adults with early executive cognitive impairment compared to other antihypertensive regimens?
p-value: p=0.008
Candesartan may provide superior cognitive protection, specifically for executive function, compared to ACE inhibitors or diuretics in older adults with hypertension and early cognitive impairment.
Approximately 50% of older hypertensive individuals have difficulties in executive function, the cognitive domain that controls complex tasks.1 Hypertensive individuals with executive dysfunction have a high rate of conversion to dementia.2 To date, no study has investigated therapeutic options for executive dysfunction. Recent evidence suggest that the renin angiotensin system plays a central role in linking hypertension to cognitive function offering new therapeutic options for cognitive protection.3 In the brain, angiotensin receptor blockers (ARB) block the type 1 but not type 2 whereas angiotensin converting enzyme inhibitors (ACEI) decrease activation of both receptors. Activating the type 2 receptor may provide cognitive protection.4 We therefore hypothesized that an ARB-based regimen would be superior to other antihypertensive regimens in cognitive protection, especially executive function, and conducted a 12-month double blind randomized clinical trial comparing candesartan, lisinopril, and HCTZ in hypertensives with early executive dysfunction.
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Hajjar et al. (2012) conducted an RCT in Hypertension with early executive cognitive impairment (n=53). Candesartan vs. Lisinopril or Hydrochlorothiazide (HCTZ) was evaluated on Improvement in Trail Making Test part B (TMT-B) (p=0.008). Candesartan demonstrated the greatest improvement in executive function as measured by TMT-B (p=0.008) compared to lisinopril and HCTZ in hypertensive older adults.
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