IS THE COGNITIVE FUNCTION OF OLDER PATIENTS AFFECTED BY ANTIHYPERTENSIVE TREATMENT - RESULTS FROM 54 MONTHS OF THE MEDICAL-RESEARCH COUNCILS TREATMENT TRIAL OF HYPERTENSION IN OLDER ADULTS

Objective-To establish whether initiation of treatment with diuretic o r beta blocker is associated over 54 months with change in cognitive f unction. Design-A cognitive substudy, nested within a randomised, plac ebo controlled, single blind trial. Setting-226 general practices hom the Medical Research Council's general practice research framework. Su bjects-A subset of 2584 subjects sequentially recruited from among the 4396 participants aged 65-74 in the trial of treatment of hypertensio n in older adults. The 4396 subjects were randomised to receive diuret ic, beta blocker, or placebo. Subjects had mean systolic pressures of 160-209 mm Hg and mean diastolic pressures <115 mm Hg during an eight week run in. Outcome measures-The rate of change in paired associate l earning test (PALT) and trail making test part A (TMT) scores (adminis tered at entry and at 1, 9, 21, and 54 months) over time. Results-Ther e was no difference in the mean learning test coefficients (rate of ch ange of score over time) between the three treatments: diuretic -0.31 (95% confidence interval -0.23 to -0.39), beta blocker -0.33 (-0.25 to -0.41), placebo -0.30, (-0.24 to -0.36). There was also no difference in the mean trail making coefficients (rate of change in time taken t o complete over time) between the three groups: diuretic -2.73 (95% co nfidence interval -3.57 to -1.88), beta blocker -2.08 (-3.29 to -0.87) , placebo -3.01, (-3.69 to -2.32). A less conservative protocol analys is confirmed this negative finding. Conclusion-Treating moderate hyper tension in older people is unlikely to influence, for better or for wo rse, subsequent cognitive function.