THE ASSOCIATION OF ANTIHYPERTENSIVE AGENTS WITH MRI WHITE-MATTER FINDINGS AND WITH MODIFIED MINI-MENTAL-STATE-EXAMINATION IN OLDER ADULTS

OBJECTIVES: To examine the association of antihypertensive regimen wit h magnetic resonance imaging (MRI) white matter hyperintensity and wit h cognitive impairment in older adults. DESIGN: Cross-sectional study. SETTING: The Cardiovascular Health study, an observational prospectiv e cohort study of risk factors for coronary heart disease and stroke i n men and women 65 years of age and older. PARTICIPANTS: 1268 men and women with pharmacologically treated hypertension. MEASUREMENTS: Infor mation on medication use, medical history, and health habits was colle cted at clinic examinations. Participants completed the Modified Mini- Mental State Examination (3MS) and underwent MRI examination. Without clinical information, study neuroradiologists assigned an overall grad e of white matter signal intensity on MRI on a scale from 0 (no findin gs) to 9 (extensive findings). RESULTS: Adjusted mean white matter gra de was higher for users of calcium channel blockers (2.59, P = .007) a nd users of loop diuretics (2.60, P = .015) than for users of beta blo ckers (2.12). The association was present for both dihydropyridine and non-dihydropyridine calcium channel blockers. Adjusted mean 3MS score s were lower for users of calcium channel blockers (89.6, P < .002), e specially dihydropyridines, and users of loop diuretics (89.7, P < .00 6) than for users of beta blockers (92.3). No statistically significan t association could be shown for users of other drug regimens, includi ng thiazides and ACE inhibitors. CONCLUSION: In this study, users of a ntihypertensive regimens which included calcium channel blockers or lo op diuretics had more severe white matter hyperintensity on MRI and wo rse performance on 3MS than users of beta blockers.