Comparison of losartan and hydrochlorothiazide on cognitive function and quality of life in hypertensive patients

We examined long-term changes in cognitive function and quality of life (QL ) in hypertensive patients by comparing the antihypertensive effect of hydr ochlorothiazide (HCTZ) and losartan, We studied 69 patients (age range, 30 to 73 years) with mild-to-moderate hypertension, All patients, in a double- blind study, were randomly allocated to either treatment with 50 mg losarta n once daily or 25 mg NCTZ once daily. The sample in each treatment group w as divided by age (younger than 60 years or 60 years or older). At baseline and after 26 months, a QL questionnaire appropriate for the hypertensive p atients was given. Cognitive function was evaluated, at baseline and after 26 months, by psychometric tests consisting of: hems from the Mini-Mental S tate Examination (MMSE) and the Sandoz Clinical Assessment Geriatric (SCAG) . A score of less than 24 on the MMSE and more than 40 on the SCAG was pred ictive of cognitive impairment. The losartan group had a significant improv ement in SCAG (P < .001) and MMSE (P < .001). No significant changes were o bserved in the NCTZ group (SCAG, P = .1; MMSE, P = .2), Sixty-five percent of the elderly had a MMSE score less than 24 and 70% had a SCAG score great er than 40, v 35% and 48%, respectively, in younger patients, The health st ate index of at improved significantly in both groups (losartan group, P < .01; NCTZ group, P < .02); the improvement in QL scores in patients using H CTZ was significant only in subjects aged 60 years and older (P < .04). The se results suggest that losartan can have a positive effect not: only on bl ood pressure but also on impaired cognitive function, reversing even minima l cognitive deficits induced by hypertension. The elderly patients in our s ample had worse scores and cognitive performance was lower than in younger patients, even if in the losartan group the score improvement was the same at all ages. The same could not be said for HCTZ. (C) 1999 American Journal of Hypertension, Ltd.