Blood Pressure Responses to Hypertension Treatment and Trends in Cognitive Function in Patients With Initially Difficult-to-Treat Hypertension: A Retrospective Subgroup Analysis of the Observational Study on Cognitive Function and SBP Reduction (OSCAR) Study

Authors

  • Robert J. Petrella MD, PhD,

    1. From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France5
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  • 1 Evgeny Shlyakhto MD,

    1. From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France5
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  • 2 Alexandra O. Konradi MD,

    1. From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France5
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  • 2 Jean-Pascal Berrou MD,

    1. From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France5
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  • 3 Armand Sedefdjian MSc,

    1. From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France5
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  • 4 Atul Pathak MD,

    1. From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France5
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  • and 5 On behalf of the OSCAR Publication Group

    1. From the Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, Ontario, Canada ; 1the VA Almazov Federal Center for Heart, Blood and Endocrinology, St Petersburg, Russia ; 2Global Medical Affairs, Abbott Products Operations, Allschwil, Switzerland ; 3Evidence Based Communication, Chemin de la Jonchère, Rueil-Malmaison, France ; 4 and the Department of Clinical Pharmacology, Centre Hospitelier Universitaire de Toulouse, INSERM-URM-1048, U de Toulouse III Paul Sabatier, Toulouse, France5
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Robert Petrella, MD, PhD, Department of Family Medicine and Cardiology, Lawson Health Research Institute, University of Western Ontario, 801 Commissioners Road, London, Ontario, N6C 5J1, Canada
E-mail:petrella@uwo.ca

Abstract

J Clin Hypertens (Greenwich). 2012;14:78–84. ©2012 Wiley Periodicals, Inc.

The Observational Study on Cognitive Function and SBP Reduction (OSCAR) provided opportunities to examine the influence of eprosartan on trends in cognitive performance in a large population of patients with difficult-to-treat hypertension (DTTH). A total of 4649 patients diagnosed retrospectively with DTTH, defined as systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mm Hg despite use of at least 3 antihypertensive drugs during the month preceding the baseline visit comprised the intention-to-treat (ITT) cohort. The patients were given eprosartan-based antihypertension therapy (EBT; 600 mg/d). Blood pressure and cognitive function parameters included significant (P<.001) differences for DTTH vs non-DTTH patients such as older age, body mass index, SBP and pulse pressure (PP), and lower Mini-Mental State Examination (MMSE) score. After EBT for 6 months, SBP/DBP in DTTH was 138.8±12.2/81.9±7.4 (ΔSBP−26±15.7; ΔDBP−11.4±9.8); PP was 57.0±10.8 (ΔPP−14.5±13.8) (all P<.001 vs baseline and non-DTTH group). A total of 2576 patients (87.4%) responded to EBT (ie, SBP <140 mm Hg and/or ΔSBP ≥15 mm Hg, or DBP <90 mm Hg and/or ΔDBP ≥10 mm Hg); 1426 DTTH patients (48.4%) achieved normalized SBP/DBP (ie, SBP <140 mm Hg and DBP <90 mm Hg). ΔPP in DTTH-isolated systolic hypertension (ISH) was −18.0±13.3 mm Hg (P=.003 vs DTTH-systolic-diastolic hypertension). End-of-EBT mean MMSE was 27.5±3.0 (P<.001 vs baseline). Blood pressure responses after EBT coincided with stabilization/improvement of MMSE in this retrospective investigation in DTTH patients. The average improvement in MMSE in DTTH patients was similar to that in non-DTTH patients. EBT effects on PP may be relevant to the evolution of MMSE in DTTH-ISH patients.

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