COMBINED ANTIHYPERTENSIVE THERAPY EFFECTIVENESS IN ELDERLY PATIENTS WITH COGNITIVE DYSFUNCTION

The dynamics of 24-hour blood pressure monitoring (BPM) and cognitive function parameters was assessed in 108 elderly patients with arterial hypertension (AH), who received combined antihypertensive therapy including Mexicor. All patients were randomized into three groups. Antihypertensive treatment included Mexicor in combination with either Ravel (indapamide), or Felodip (felodipine), or Lorista (losartan). Parallel groups were treated with Ravel, Felodip, or Lorista only, without Mexicor. Cognitive dysfunction and its dynamics were assessed by MMSE (Mini-Mental State Examination), clock drawing test, and Schulte test. The maximal beneficial dynamics of BPM parameters was observed for the combined therapy with Ravel and Mexicor, being slightly less pronounced for the combined therapy with Lorista and Mexicor, or Felodip and Mexicor. Target BP levels were achieved in 66,7%, 52,2%, and 47,6% of the patients, respectively. Adding a cytoprotector Mexicor to the complex antihypertensive therapy resulted in cognitive function improvement. The combination of Ravel and Lorista with Mexicor was associated with a significant improvement in cognitive function only in patients who achieved target BP levels, while the combination of Felodip and Mexicor improved MMSE scores in all patients, regardless of target BP achievement. Therefore, in elderly AH patients, the addition of a cytoprotector Mexicor to the complex antihypertensive therapy is associated with improved cognitive function.

1. Белова А.Н. Шкалы, тесты и опросники в неврологии и нейрохирургии. Руководство для врачей и научных работников. М; 2004.

2. Захаров В.В. Всероссийская программа исследований эпидемиологии и терапии когнитивных расстройств в пожилом возрасте (“Прометей”)// Неврологический журнал 2006; 11: 27–32.

3. Кобалава Ж.Д. Артериальное давление в исследовательской и клинической практике / Ж.Д.Кабалава, Ю.В.Котовская, В.Н.Хирманов; под ред. В.С.Моисеева, Р.С.Карпова. – М., 2004.

4. Михин В.П., Болдина Н.В., Чернятина М.А., Ласков В.Б., Сидорова С.А. Эффективность кардиоцитопротектора Мексикор в составе комплексной терапии больных с острой церебральной дисциркуляцией на фоне артериальной гипертонии // Журнал Ангиология и сосудистая хирургия 2008; 4: 43-48.

5. Остроумова О.Д, Корсакова Н.K., Баграмова Ю.А. Деменция и артериальная гипертензия у пожилых больных: возможности препарата Физиотенз// РМЖ 2002;10(1):7–10.

6. Хлебодаров Ф.Е., Михин В.П., Иваненко Л.Н Эффективность терапии Мексикором у пациентов с гипертонической болезнью//Журнал Terra medica nova 2008; 3:23-27.

7. Яхно Н.Н. Когнитивные расстройства в неврологической клинике //Неврологический журнал 2006;1:4-12

8. Elias M.F., Wolf P.A., D`Agostino, et all. Untreated blood pressure level is inversely reated to cognitive functioning: the Framingham Study. Am J Epidemiol 1993; 138(6):353–64.

9. Forette F., Seux M.L., Staessen J.A. et al. Prevention of dementia in randomised double-blind placebo-conrolled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352: 1347-1351.

10. Hulley SB, Furberg CD, Gurland B, McDonald R, Perry HM, Schnaper HW, Schoenberger JA, Smith WM, Vogt TM. Systolic Hypertension in the Elderly Program (SHEP): antihypertensive efficacy of chlorthalidone// Am J Cardiol. 1985 Dec 1; 56(15):913-20.

11. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358: 1033-1041.

12. Trenkwalder P. The Study on COgnition and Prog nosis in the Elderly (SCOPE) – recent analyses. J Hypertens Suppl. 2006; 24 (1): 107–14.