Treatment of isolated systolic hypertension in elderly and prevention of dementia: the Syst-Eur vascular dementia project

The aim of the vascular dementia project, set up in the framework of the do uble-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) tr ial, was to investigate the influence of antihypertensive drug treatment on the incidence of vascular dementia. The study was run on non-demented patients, at least 60 years old, with iso lated systolic hypertension (sitting blood pressure of 160-219 mmHg for sys tolic and below 95 mmHg for diastolic). Treatment was initiated with nitren dipine (10-40 mg/day) possibly associated with enalapril (5-20 mg/day) and/ or hydrochlorothiazide (1.2.5-25 mg/day). Cognitive function was assessed a t baseline and annually by the Mini Mental State Examination (MMSE). The di agnosis of dementia was based on the DSM-III-R criteria. The etiology of de mentia was established using the Modified Ischemic Score or the Hachinski s core when brain imaging was not available. Median follow-up by intention-to -treat was 2.0 years. The incidence of dementia was reduced by 50% from 7.7 per 1000 patient-years in the placebo group (number of patients 1 180) to 3.7 cases per 1000 p-a in the active treatment group (n = 1 238) (21 vs 11 patients, p=0.05). At the last available evaluation, systolic and diastolic blood pressure were 8.3 mmHg and 3.8 mm Hg lower (p less than or equal to 0.001) in the active-treatment group, but on average the MMSE scores remain ed stable in both groups, Conclusion. In older people with isolated systolic hypertension, antihypert ensive treatment started with nitrendipine may reduce the incidence of deme ntia. At the rate observed in the placebo group, treating 1 000 patients fo r 5 years would prevent 19 cases of dementia.