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Losartan Improves Cognitive Function in Elderly Hypertensive Patients

While losartan and atenolol show equivalent effectiveness on the reduction of blood pressure in elderly hypertensive patients, only losartan improves immediate and delayed memory function, according to a recent Italian study.

Contradicting data have been obtained regarding the relationship between hypertension and cognitive impairment, particularly in older patients.

Furthermore, differential effects on cognitive function have been observed between antihypertensive drugs, regardless of their hypotensive effectiveness. It does appear, however, that angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II (AngII) antagonists have a positive influence on mental function.

Roberto Fogari, MD, and colleagues at the University of Pavia, Italy, evaluated the effects of the beta-adrenergic blocker atenolol and the Angiotensin II type 1 (AT1) receptor antagonist losartan on cognitive function in elderly hypertensive patients.

The study included 120 patients between the ages of 75 and 89 with mild to moderate essential hypertension (DBP >90 and <105mmHg and SBP <200 mmHg). After a 4-week placebo wash out, patients were randomised to receive atenolol (50 mg) or losartan (50 mg) for 24 weeks.

At the end of the placebo and active treatment periods, blood pressure was measured using a mercury sphygmomanometer (Korotkoff I and V) and cognitive function was assessed by the word list memory, word list recall and word list fluency tests.

Both atenolol and losartan significantly lowered systolic blood pressure (SBP) and diastolic blood pressure (DBP) from baseline values. SBP dropped 22.1 mmHg with atenolol treatment and 23.1 mmHg with losartan treatment. DBP decreased 10.3 and 11.2 mmHg, respectively.

However, heart rate was reduced to a greater extent in the atenolol group (-13.2 bpm) than in the losartan group (-0.6 bpm), as expected.

Patients receiving losartan showed significant improvement in both memory tests, while those receiving atenolol did not shown a difference with treatment. Losartan treatment was associated with a 2.2 point increase in word list memory score and a 2.1 point increase in the word list recall score (P<.05 for both vs. baseline).

Notably, a greater number of adverse events were reported in patients given atenolol than in those given losartan (31 vs. 8 events). Fatigue, cold extremities and dizziness were more common in the atenolol group, while headache and nausea were more frequently reported in the losartan group.

Dr. Fogari concludes that "both atenolol and losartan have the same antihypertensive efficacy in very elderly hypertensive patients; however, only losartan improves memory function, both the immediate and the delayed one."

J Hum Hypertens 2003 Nov;17:11:781-5. "Influence of losartan and atenolol on memory function in very elderly hypertensive patients"

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