Assessment of cognitive function in patients with essential hypertension treated with lercanidipine

J Tisaire-Sánchez1, J Roma2, Ignacio Camacho-Azcargorta3, J Bueno-Gómez1, J Mora-Maciá4, Angel Navarro51Fundación para la Investigación de la Hipertensión Arterial, Zaragoza, Spain; 2Fundació per l’Estudi de la Hipertensió Arterial als Hospitals Comarcals de Catalunya, Barcelona, Spain; 3Servicio de Cardiología, Clínica San José, Valencia, Spain; 4Unidad de Hipertensión Arterial, Instituto Médico Tecnológico, Barcelona, Spain; 5Recordati España, Madrid, SpainObjectives: The aim of this longitudinal, open-label, comparative, multicenter study was to assess cognitive function in hypertensive patients receiving mid-term treatment with lercanidipine.Methods: Hypertensive patients aged 40 years or older were treated with lercanidipine (10 mg daily) after 7–10 days washout period. The duration of the study was 6 months. Blood pressure (BP) was measured every 4 weeks (JNC 6th report). In patients with inadequate BP control, doxazosin was added and up-titrated. At baseline and after 6 months of treatment, cognitive function was evaluated using the Spanish validated version of the Mini-Mental State Examination (MMSE) and the Trail Making Test (TMT). Results: In the study population of 467 patients, BP decreased from 154.4/95.3 mmHg at baseline to 134.8/80.7 mmHg at 6 months. At the end of the study, 98% of patients were receiving lercanidipine, 20% an angiotensin-converting enzyme inhibitor, and 6% doxazosin. Adequate BP control was obtained in 68% of patients. The mean (standard deviation) MMSE scores improved from 32.35 (2.59) to 33.25 (2.36) (p<0.0001). Patients with good BP control scored significantly better than those with inadequate BP control (p<0.05), which was already observed at the first month. Conclusions: The third-generation calcium channel antagonist, lercanidipine, improved cognitive function after 6 months of treatment especially in patients with good BP control, suggesting that improvements in cognitive function may be associated with a decrease in BP. Keywords: lercanidipine, hypertension, cognitive functio

ASSESSMENT OF COGNITIVE FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION TREATED WITH LERCANIDIPINE

The aim of this longitudinal, open-label, comparative, multi-centre study was to assess cognitive function in hypertensive patients receiving mid-term treatment with lercanidipine. Hypertensive patients aged 40 years or older were treated with lercanidipine (10 mg daily) after 7–10 days washout period. The duration of the study was 6 months. Blood pressure (BP) was measured every 4 weeks (JNC 6th report). In patients with inadequate BP control, doxazosin was added and up-titrated. At baseline and after 6 months of treatment, cognitive function was evaluated using the Spanish validated version of the Mini-Mental State Examination (MMSE) and the Trail Making Test (TMT). In the study population of 467 patients, BP decreased from 154,4/95,3 mmHg at baseline to 134,8/80,7 mmHg at 6 months. At the end of the study, 98% of patients were receiving lercanidipine, 20% – an angiotensin-converting enzyme inhibitor, and 6% – doxazosin. Adequate BP control was obtained in 68% of patients. The mean (standard deviation) MMSE scores improved from 32,35 (2,59) to 33,25 (2,36) (p<0,0001). Patients with good BP control scored significantly better than those with inadequate BP control (p<0,05), which was already observed at the first month. Conclusion: The third-generation calcium channel antagonist, lercanidipine, improved cognitive function after 6 months of treatment especially in patients with good BP control, suggesting that improvements in cognitive function may be associated with a decrease in BP

Dissociation between blood pressure reduction and fall in proteinuria in primary renal disease: a randomized double-blind trial

OBJECTIVEGuidelines recommend lower threshold and goal blood pressure (BP) for patients with proteinuria. BP reduction could be accompanied by a different fall in proteinuria depending of the antihypertensive drug. The objective was to compare proteinuria reduction when BP is lowered to the same level with different drugs.DESIGNProspective, randomized, double-blind, controlled trial.SETTING12 Spanish centres.PATIENTSA total of 119 patients with primary renal disease, blood pressure > 130/85 mmHg, proteinuria > 1 g/day, and creatinine clearance > or = 50 ml/min.INTERVENTIONAfter a 4-week run-in placebo period, patients were randomized to: atenolol 50 mg/day; trandolapril 2 mg/day; verapamil 240 mg/day or verapamil 180 + trandolapril 2 mg/day combination; forced double-dose titration was carried out at the 4th week. Treatment duration was 6 months.OUTCOME MEASURESChanges in BP, 24 h proteinuria, serum albumin and calcium.RESULTSBP was significantly reduced with the four treatments [SBP/DBP (mmHg]: atenolol 12.2/9.9; trandolapril 12.9/9.3; verapamil 8.2/7.9 and verapamil + trandolapril 13.6/11.3) without differences between them. A significant fall in proteinuria was seen in the trandolapril, 40.2% [95% confidence interval (CI) 24.3-56.2%], and verapamil + trandolapril groups, 48.5% (95% CI, 31.7-64.3%) accompanied with increases in serum albumin (trandolapril: from 3.86 +/- 0.64 to 4.03 +/- 0.67 g/dl; verapamil + trandolapril: from 4.15 +/- 0.58 to 4.40 +/- 0.51 g/dl).CONCLUSIONSIn patients with proteinuric primary renal disease, adequate dose titration of antihypertensive drugs may provide a substantial BP reduction. Only angiotensin-converting enzyme inhibitor (trandolapril) treatment, alone or better combined with verapamil, reduces proteinuria and increases serum albumin