Because high blood pressure and stroke are associated with increased risks of dementia and cognitive impairment, Australian investigators published a report on the results of a study to determine whether lowering blood pressure would reduce the risks of dementia and cognitive decline among individuals with cerebrovascular disease.
This study was a randomized, double-blind, placebo-controlled trial conducted among 6,105 people with prior stroke or transient ischemic attack. Participants were assigned to either active treatment (n=3,051) or matching placebos (n=3,054). Perindopril(Drug information on perindopril) (Aceon) was given to all participants, and indapamide(Drug information on indapamide) (Lozol) was given to those with neither an indication for nor a contraindication to a diuretic.
The primary outcomes for these analyses were dementia, (using DSM-IV criteria) and cognitive decline (a decline of ≥3 points on the Mini-Mental State Exam [MMSE] score). The results were from a mean follow-up of 3.9 years.
Dementia was documented in 193 (6.3%) of the actively treated group and 217 (7.1%) of the placebo group (relative risk reduction=12% [95% CI: -8% to 28%]; p=0.2). In the active treatment group, 9.1% of patients had a cognitive decline, as did 11% of the placebo group (risk reduction=19% [95% CI: 4% to 32%]; p=0.01). The risks of the composite outcomes of dementia with recurrent stroke and of cognitive decline with recurrent stroke were reduced by 34% (95% CI: 3% to 55%; p=0.03) and 45% (95% CI: 21% to 61%; p<0.001), respectively. There was no clear effect on either dementia or cognitive decline in the absence of recurrent stroke.
These findings, the authors concluded, indicated:
Active treatment was associated with reduced risks of dementia and cognitive decline associated with recurrent stroke. These findings further support the recommendation that blood pressure lowering with perindopril and indapamide therapy be considered for all patients with cerebrovascular disease.
Reference: Tzourio C, Anderson C, Chapman N et al. (2003), Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med 163(9):1069-1075.
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