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EDITORIALS: Lawrence J Whalley and Donald H R Mowat Aspirin and cognitive function BMJ 2007; 334: 961-962 [Full text]

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Beneficial cognitive effects of treating hypertension are not clear

David Craig, Bernadette McGuinness, Stephen Todd, A Peter Passmore, Roger Bullock   (3 June 2007)

Beneficial cognitive effects of treating hypertension are not clear 3 June 2007
David Craig, Senior Lecturer Queen's University Belfast BT9 7BL, Bernadette McGuinness, Stephen Todd, A Peter Passmore, Roger Bullock Send response to journal: Re: Beneficial cognitive effects of treating hypertension are not clear	Clinicians, tempted to alter clinical practice after reading Whalley and Mowat’s (1) declaration that “treatment of hypertension is beneficial in older people with well established cognitive benefits, possibly including transition to dementia” should exercise caution. The Cochrane Review of McGuinness et al (2) serves as a brake to those who might be tempted by attractive epidemiological data and indeed a reasonable pathophysiological argument implicating hypertension in the development of dementia. While the Syst-Eur (3) study that the authors cite did show a benefit with treatment in the prevention of dementia, the only other trials to deal with dementia prevention in those without established cerebrovascular disease namely SCOPE (4) and SHEP (5) failed to show any advantage. When the three trials were entered in a meta-analysis no significant effect was seen on either dementia rates or MMSE. Firm conclusions in this area are further limited by heterogeneity between clinical trials, the presence of adverse events leading to patient drop outs, and instances whereby control subjects received antihypertensive drugs thus lowering their blood pressure. Well established cognitive benefits? Rather a dire need to establish meaningful RCTs. 1. Kang JH, Cook N, Manson J, Buring JE, and Grodstein F. Low dose aspirin and cognitive function in the women's health study cognitive cohort, BMJ 2007;334:961-962. 2. McGuinness B, Todd S, Passmore P, Bullock R. The effects of blood pressure lowering on development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease. Cochrane Database Syst Rev 2006 Apr 19;(2):CD004034. 3. Forette F, Seux ML, Staessen JA, Thijs L, Birkenhager WH, Babarskiene MR, et al. Prevention of dementia in randomised double-blind placebo- controlled Systolic Hypertension in Europe (Syst-Eur) Trial. Lancet 1998;352:1347-51. 4. Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B et al., for the SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomised double-blind intervention trial. J Hypertens 2003;21:875-886. 5. Di Bari M, Pahor M, Franse LV, Shorr RI, Wan JY, Ferrucci L, et al. Dementia and Disability Outcomes in Large Hypertension Trials: Lessons Learned from the Systolic Hypertension in the Elderly Program (SHEP) Trial. Am J Epidemiol 2001;153:72-8. Competing interests: None declared