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BMJ. 1996 March 30; 312(7034): 801–805.
PMCID: PMC2350726

Is the cognitive function of older patients affected by antihypertensive treatment? Results from 54 months of the Medical Research Council's trial of hypertension in older adults.


OBJECTIVE--To establish whether initiation of treatment with diuretic or beta blocker is associated over 54 months with change in cognitive function. DESIGN--A cognitive substudy, nested within a randomised, placebo controlled, single blind trial. SETTING--226 general practices from the Medical Research Council's general practice research framework. SUBJECTS--A subset of 2584 subjects sequentially recruited from among the 4396 participants aged 65-74 in the trial of treatment of hypertension in older adults. The 4396 subjects were randomised to receive diuretic, beta blocker, or placebo. Subjects had mean systolic pressures of 160-209 mm Hg and mean diastolic pressures <115 mm Hg during an eight week run in. OUTCOME MEASURES--The rate of change in paired associate learning test (PALT) and trail making test part A (TMT) scores (administered at entry and at 1, 9, 21, and 54 months) over time. RESULTS--There was no difference in the mean learning test coefficients (rate of change of score over time) between the three treatments: diuretic -0.31 (95% confidence interval -0.23 to -0.39), beta blocker -0.33 (-0.25 to -0.41), placebo -0.30, (-0.24 to -0.36). There was also no difference in the mean trail making coefficients (rate of change in time taken to complete over time) between the three groups: diuretic -2.73 (95% confidence interval -3.57 to -1.88), beta blocker -2.08 (-3.29 to -0.87), placebo -3.01, (-3.69 to -2.32). A less conservative protocol analysis confirmed this negative finding. CONCLUSION--Treating moderate hypertension in older people is unlikely to influence, for better or for worse, subsequent cognitive function.

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Selected References

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  • Elias MF, Wolf PA, D'Agostino RB, Cobb J, White LR. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol. 1993 Sep 15;138(6):353–364. [PubMed]
  • Farmer ME, Kittner SJ, Abbott RD, Wolz MM, Wolf PA, White LR. Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: the Framingham Study. J Clin Epidemiol. 1990;43(5):475–480. [PubMed]
  • Farnett L, Mulrow CD, Linn WD, Lucey CR, Tuley MR. The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA. 1991 Jan 23;265(4):489–495. [PubMed]
  • Farmer ME, White LR, Abbott RD, Kittner SJ, Kaplan E, Wolz MM, Brody JA, Wolf PA. Blood pressure and cognitive performance. The Framingham Study. Am J Epidemiol. 1987 Dec;126(6):1103–1114. [PubMed]
  • Bird AS, Blizard RA, Mann AH. Treating hypertension in the older person: an evaluation of the association of blood pressure level and its reduction with cognitive performance. J Hypertens. 1990 Feb;8(2):147–152. [PubMed]
  • Wilkie F, Eisdorfer C. Intelligence and blood pressure in the aged. Science. 1971 May 28;172(3986):959–962. [PubMed]
  • Waldstein SR, Ryan CM, Manuck SB, Parkinson DK, Bromet EJ. Learning and memory function in men with untreated blood pressure elevation. J Consult Clin Psychol. 1991 Aug;59(4):513–517. [PubMed]
  • INGLIS J. A paired-associate learning test for use with elderly psychiatric patients. J Ment Sci. 1959 Apr;105(439):440–443. [PubMed]
  • Little A, Hemsley D, Bergmann K, Volans J, Levy R. Comparison of the sensitivity of three instruments for the detection of cognitive decline in elderly living at home. Br J Psychiatry. 1987 Jun;150:808–814. [PubMed]
  • van Swieten JC, Geyskes GG, Derix MM, Peeck BM, Ramos LM, van Latum JC, van Gijn J. Hypertension in the elderly is associated with white matter lesions and cognitive decline. Ann Neurol. 1991 Dec;30(6):825–830. [PubMed]

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