Treatment of isolated systolic hypertension and dementia prevention in older patients - Results of the Systolic Hypertension in Europe Trial (SYST-EUR) vascular dementia project

Aims The purpose of the vascular dementia project, set up in the framework of the double-blind placebo-controlled Systolic Hypertension in Europe (SYS T-EUR) trial, was to investigate whether antihypertensive drug treatment co uld reduce the incidence of dementia. Methods and Results The study was run on nondemented patients, at least 60 years old, with isolated systolic hypertension. Treatment was initiated wit h nitrendipine (10-40 mg. day(-1)) possibly associated with enalapril (5-20 mg. day(-1) ) and/or hydrochlorothiazide (12.5-25 mg. day(-1)). Cognitive function was assessed by the Mini Mental State Examination (MMSE). The diag nosis of dementia was based on the DSM-III-R criteria. The aetiology of dem entia was established using either the Modified Ischaemic Score with brain imaging or the Hachinski score. The median time of follow-up was 2.0 years. By intention-to-treat, the incidence of dementia was reduced by 50% from 7 7 per 1000 patients-years in the placebo group (number of patients 1180) to 3.7 cases per 1000 patient-years in the active treatment one (n=1238) (21 vs 11 patients, P=0.05). At the last available evaluation, systolic and dia stolic blood pressure were 8.3 mmHg and 3.8 mmHg lower (P<0.001) in the act ive-treatment group, but on average the MMSE scores remained: stable in bot h groups. Conclusion In older people with isolated systolic hypertension, antihyperte nsive treatment started with nitrendipine reduced the incidence of dementia .