Antihypertensive Therapy and Cerebral Hemodynamics in Executive Mild Cognitive Impairment: Results of a Pilot Randomized Clinical Trial
Article first published online: 25 JAN 2013
© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 61, Issue 2, pages 194–201, February 2013
How to Cite
Hajjar, I., Hart, M., Chen, Y.-L., Mack, W., Novak, V., C. Chui, H. and Lipsitz, L. (2013), Antihypertensive Therapy and Cerebral Hemodynamics in Executive Mild Cognitive Impairment: Results of a Pilot Randomized Clinical Trial. Journal of the American Geriatrics Society, 61: 194–201. doi: 10.1111/jgs.12100
- Issue published online: 13 FEB 2013
- Article first published online: 25 JAN 2013
- National Institute on Aging. Grant Numbers: P01-AG004390, R37-AG025037
- National Institutes of Health. Grant Numbers: P01-AG004390, R37-AG025037
- (NIA). Grant Numbers: P01-AG004390, R37-AG025037
- National Center for Research Resources . Grant Number: UL1 RR031986
- angiotensin receptor blocker;
- cerebrovascular circulation;
- executive function hemodynamics;
To compare the effects of three antihypertensive medications on cerebral hemodynamic and cognitive function in hypertensive individuals with executive dysfunction.
Double-blind randomized clinical trial.
Fifty-three individuals aged 60 and older with hypertension and executive dysfunction.
Lisinopril, candesartan, or hydrochlorothiazide for 1 year.
Cerebral blood flow velocity (BFV; transcranial Doppler ultrasonography during rest, sitting, standing, hypercapnia, and hypocapnia), cognition, and blood pressure were measured at baseline and after 6 and 12 months. Linear mixed models were used to compare the three groups.
Of the 53 participants, 47 had successful insonation (mean age 72; 70% white; 57% women). There was a tendency toward an increase in BFV in the candesartan group and a decrease in the lisinopril and hydrochlorothiazide groups (between-group P = .57) that was significant in those with low BFV at baseline (<median 27.6 cm/s, between-group P = .03). The candesartan group also had the greatest improvement in executive function (Trail Making Test Part B improved by 17.1 seconds, vs hydrochlorothiazide improved by 4.2 seconds and lisinopril worsened by 14.4 seconds, P = .008). Carbon dioxide vasoreactivity and vasomotor range declined significantly in the lisinopril (within-group P = .001 for vasoreactivity and .02 for vasomotor range) and hydrochlorothiazide groups (within-group P = .10 and .009, respectively) but not in the candesartan group (within-group P = .25 and .38, respectively; between-group P = .30 and .46, respectively).
Angiotensin receptor blockers may preferentially preserve cerebral hemodynamics and executive function in individuals with executive dysfunction. These findings warrant further investigation in a larger trial.