TY - JOUR
T1 - Effects of sartans and low-dose statins on cerebral white matter hyperintensities and cognitive function in older patients with hypertension
T2 - a randomized, double-blind and placebo-controlled clinical trial
AU - Zhang, Hua
AU - Cui, Yi
AU - Zhao, Yingxin
AU - Dong, Yuanli
AU - Duan, Dandan
AU - Wang, Juan
AU - Sheng, Lin
AU - Ji, Tiantian
AU - Zhou, Tingting
AU - Hu, Wenjing
AU - Chen, Yali
AU - Sun, Shangwen
AU - Gong, Gary
AU - Chai, Qiang
AU - Liu, Zhendong
N1 - Funding Information:
Acknowledgements We are grateful to the participating patients, general practitioners, and nurses who were involved in this study and would like to thank all the people who provided help in this study. This work was supported by the National Natural Science Foundation of China (81670432, 81470489, 81500232); Natural Science Foundation of Shandong Province, China (ZR2014HM098, ZR2016HM82, ZR2014HL012); the Key Research and Development Project of Shandong Province (2018GSF118044, 2017GSF218060, 2017GSF18169, 2011GSF11822); the Project of Healthy and Family Planning Commission of Shandong Province (2017WS076); the Project of Shandong Academy of Medical Sciences (2017-32); and the Innovation Project of Shandong Academy of Medical Sciences.
Publisher Copyright:
© 2018, The Japanese Society of Hypertension.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Cerebral white matter hyperintensities (WMHs) and cognitive impairment are common in elderly hypertensive patients, and more needs to be learned about their prevention and treatment. Our aim was to investigate the effect of low-dose statins on WMH and cognitive function in elderly patients undergoing antihypertensive treatment. A total of 732 elderly hypertensive patients taking hydrochlorothiazide as their baseline medication were randomized using a 2 × 2 factorial design with antihypertensive (telmisartan vs. placebo) and lipid-modulating (low-dose rosuvastatin vs. placebo) arms. Brain magnetic resonance imaging (MRI) and cognitive function data were obtained. After a mean follow-up time of 59.8 (range 12–65) months, there were no differences in WMH progression and cognitive function decline over time between the groups in the antihypertensive arm. The risks of new-incident WMH Fazekas scale scores ≥ 2 and the incidence of cognitive impairment did not differ between the telmisartan and placebo groups. Rosuvastatin use was associated with lower risks of new-incident Fazekas scale scores ≥2 (hazard ratio = 0.500; 95% confidence interval: 0.34–0.74) and cognitive impairment (hazard ratio = 0.54; 95% confidence interval: 0.36–0.80). Telmisartan interacted with rosuvastatin on reducing WMH progression and cognitive function decline. Findings suggest that low-dose rosuvastatin could reduce WMH progression and cognitive function decline in antihypertensive patients, as demonstrated by the interaction between telmisartan and low-dose rosuvastatin to this effect.
AB - Cerebral white matter hyperintensities (WMHs) and cognitive impairment are common in elderly hypertensive patients, and more needs to be learned about their prevention and treatment. Our aim was to investigate the effect of low-dose statins on WMH and cognitive function in elderly patients undergoing antihypertensive treatment. A total of 732 elderly hypertensive patients taking hydrochlorothiazide as their baseline medication were randomized using a 2 × 2 factorial design with antihypertensive (telmisartan vs. placebo) and lipid-modulating (low-dose rosuvastatin vs. placebo) arms. Brain magnetic resonance imaging (MRI) and cognitive function data were obtained. After a mean follow-up time of 59.8 (range 12–65) months, there were no differences in WMH progression and cognitive function decline over time between the groups in the antihypertensive arm. The risks of new-incident WMH Fazekas scale scores ≥ 2 and the incidence of cognitive impairment did not differ between the telmisartan and placebo groups. Rosuvastatin use was associated with lower risks of new-incident Fazekas scale scores ≥2 (hazard ratio = 0.500; 95% confidence interval: 0.34–0.74) and cognitive impairment (hazard ratio = 0.54; 95% confidence interval: 0.36–0.80). Telmisartan interacted with rosuvastatin on reducing WMH progression and cognitive function decline. Findings suggest that low-dose rosuvastatin could reduce WMH progression and cognitive function decline in antihypertensive patients, as demonstrated by the interaction between telmisartan and low-dose rosuvastatin to this effect.
KW - Cognitive impairment
KW - Neuroprotective effect
KW - Vascular risk factor
KW - White matter lesions
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U2 - 10.1038/s41440-018-0165-7
DO - 10.1038/s41440-018-0165-7
M3 - Article
C2 - 30552406
AN - SCOPUS:85058461246
SN - 0916-9636
VL - 42
SP - 717
EP - 729
JO - Hypertension Research
JF - Hypertension Research
IS - 5
ER -