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Lancet Neurol. 2008 Aug;7(8):683-9. doi: 10.1016/S1474-4422(08)70143-1. Epub 2008 Jul 7.

Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial.

Collaborators (229)

Warne R, Puddey I, Woodward M, Penhall R, Inderjeeth C, Roger S, Scholes R, Johnson C, Celis H, Adriaens G, Onsea W, Cornelli K, Vantroyen D, Cleen P, de Voogt P, Stoyanovsky V, Solakov P, Nachev C, Prokopova X, Mantova E, Smilkova D, Mantov S, Yankulova K, Kermova R, Popov D, Sirakova V, Gergova V, Kamenova D, Grigorov F, Vassileva T, Alahverdian R, Tzekova M, Liu L, Ge H, Wang S, Wang J, Zhang W, Jin S, Ge L, Lu YF, Ma S, Shen L, Guo J, Lv Z, Huang R, Li X, Guo B, Zhang T, Zhang L, Feng J, He Z, Wang J, Deng L, Liu L, Yuan Q, Zhang F, Li H, Wang D, Yang K, Sun M, Liu H, Yan X, Ren F, Tang J, Antikainen R, Strandberg T, Konttila T, Hynninen A, Jääskivi M, Airas J, Jääskeläinen T, Tuomilehto J, Litmanen H, Forette F, Doucet J, Belmin J, Benetos A, Berrut G, Boge T, Bonnefoy M, Carre A, Charasz N, Covillard J, Dantoine T, Escande M, Frances Y, Joire X, Jeandel C, Legrain S, Lion A, Maillet-Vioud M, Escaillas JP, Meaume S, Pfitzenmeyer P, Puisieux F, Quercy X, Rodat O, Soubeyrand J, de Wazieres B, Hindennach H, Lugassy L, Rossi J, Martel M, Paladel JM, Ravier C, Visconti A, Gallet JP, Zygouritsas D, Charles D, Flamand F, Grandmottet G, Grandmottetegermann M, Gevrey C, Mesnier PL, Robert G, Besset-Prat C, Brousse A, Lafont P, Morelli J, Vernede P, Volkmann A, Bodin X, Destrube B, Eoche R, Boye A, Seropian F, Gernigon P, Meker D, Thomere J, Thual Y, Volny F, Grassart E, Herent M, Lejay D, Lopez JP, Mannessier B, Pruvost G, Urbina JC, Duggan J, Anderson C, Lillis S, Gommans J, Grodzicki T, Chodorowski Z, Gaciong Z, Dumitrascu D, Comsa M, Sandru V, Prada G, Dunca-Moisin M, Jianu D, Jinga-Lazar D, Enachescu V, Zaharia C, Nikitin Y, Kirichenko A, Olbinskaya L, Martynov A, Zadionchenko V, Moiseev V, Storohzakov G, Nedogoda S, Karpov RS, Barbarash O, Efremushkin G, Kostenko V, Boyarkin M, Churina S, Tyurina T, Ballyuzek M, Ermoshkina L, Timofeev A, Yakusheva S, Shilkina N, Barbarich V, Belhani A, Boughzela E, çSoraya, Ali BY, Houman BK, Kheder Abida A, Rajkumar C, Wilkins M, Pandita-Gunawardena ND, Potter J, Ekpo E, Price M, de Kare-Silver N, Starczewski A, Chandran S, Nasar X, Datta-Chaudhuri M, McCormack T, Majmudar N, Gordon A, Brawn L, Solanki T, Bulpitt CJ, Fletcher A, Beckett NS, Peters R, McCormack T, Potter J, Extremera BG, Sever P, Forette F, Dumitrascu D, Swift C, Tuomilehto J, Coope J, Staessen J, Thijs L, Clarke R, Narkiewicz K, Davidson C, Duggan J, Leonetti G, Gainsborough N, De Vernejoul MC, Wang J, Stoyanovsky V, Tuomilehto J, Clarke R, Waldman A, Walton I, Ritichie C, Fagard R, Grimley Evans J, Williams B.

Author information

  • 1Care of the Elderly, Imperial College London, London, UK. r.peters@imperial.ac.uk

Abstract

BACKGROUND:

Observational epidemiological studies have shown a positive association between hypertension and risk of incident dementia; however, the effects of antihypertensive therapy on cognitive function in controlled trials have been conflicting, and meta-analyses of the trials have not provided clear evidence of whether antihypertensive treatment reduces dementia incidence. The Hypertension in the Very Elderly trial (HYVET) was designed to assess the risks and benefits of treatment of hypertension in elderly patients and included an assessment of cognitive function.

METHODS:

FINDINGS:

3336 HYVET participants had at least one follow-up assessment (mean 2.2 years) and were included: 1687 participants were randomly assigned to the treatment group and 1649 to the placebo group. Only five reports of adverse effects were attributed to the medication: three in the placebo group and two in the treatment group. The mean decrease in systolic blood pressure between the treatment and placebo groups at 2 years was systolic -15 mm Hg, p<0.0001; and diastolic -5.9 mm Hg, p<0.0001. There were 263 incident cases of dementia. The rates of incident dementia were 38 per 1000 patient-years in the placebo group and 33 per 1000 patient-years in the treatment group. There was no significant difference between treatment and placebo groups (hazard ratio [HR] 0.86, 95% CI 0.67-1.09); however, when these data were combined in a meta-analysis with other placebo-controlled trials of antihypertensive treatment, the combined risk ratio favoured treatment (HR 0.87, 0.76-1.00, p=0.045).

INTERPRETATION:

Antihypertensive treatment in elderly patients does not statistically reduce incidence of dementia. This negative finding might have been due to the short follow-up, owing to the early termination of the trial, or the modest effect of treatment. Nevertheless, the HYVET findings, when included in a meta-analysis, might support antihypertensive treatment to reduce incident dementia.

Comment in

PMID:
18614402
[PubMed - indexed for MEDLINE]
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