Can antihypertensive treatment also have a beneficial effect on neurocognitive functions?
Observational studies suggest that a desirable side effect of AT1 receptor blockers for angiotensin II (sartans) could be cognitive protection of patients. A randomized study published last year evaluated the potential positive impact of candesartan and lisinopril on neurocognitive functions in older patients with mild cognitive impairment (MCI).
Methodology and Study Course, Monitored Population
Patients older than 55 years with MCI and hypertension were enrolled in the study conducted between June 2014 and December 2018. Their previous antihypertensive treatment was discontinued, and they were subsequently randomized in a 1:1 ratio to treatment with candesartan (up to 32 mg/day) or lisinopril (up to 40 mg/day). Additionally, open label other antihypertensives could be administered if needed to achieve blood pressure (BP) values < 140/90 mmHg.
Participants underwent cognitive function tests at the beginning of the observation, and after 6 and 12 months. MRI brain scans were taken at the beginning of the observation and after 12 months.
A total of 176 patients with an average age of 66 years (of which 101 were women) were included in the study. 87 participants received candesartan and 89 lisinopril. The study was completed by 141 patients – 77 in the candesartan arm and 64 in the lisinopril arm.
Results
Both groups showed similar BP values. After 12 months, the average value was 130/77 mmHg in the candesartan group and 134/78 mmHg in the lisinopril group (p = 0.20 for systolic BP and 0.52 for diastolic BP).
The study results showed the superiority of candesartan compared to lisinopril in the evaluation of executive functions measured by the trail making test (part B: effect size [ES] −12.8; 95% confidence interval [CI] −22.5 to −3.1). However, this result was not observed using the EXAMINER cognitive test battery (Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research tool: ES −0.03; 95% CI −0.08 to 0.03). Candesartan was also superior to lisinopril in the revised Hopkins verbal learning test in the parameters of recall (ES 0.4; 95% CI 0.02–0.8) and memory retention (ES 5.1; 95% CI 0.7–9.5).
Conclusion
The study results suggest that in older patients with mild cognitive impairment, a one-year treatment with candesartan has a superior neurocognitive effect compared to lisinopril. This phenomenon is apparently not tied to the effects of candesartan on lowering blood pressure.
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Source:
Hajjar I., Okafor M., McDaniel D. et al. Effects of candesartan vs lisinopril on neurocognitive function in older adults with executive mild cognitive impairment: a randomized clinical trial. JAMA Netw Open 2020 Aug 3; 3 (8): e2012252, doi: 10.1001/jamanetworkopen.2020.12252.
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