Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Improving the cognitive functions in the middle-aged patients with essential arterial hypertension after the treatment with amlodipine/valsartan single-pill combination

https://doi.org/10.20996/1819-6446-2019-15-1-54-62

Full Text:

Abstract

Different antihypertensive drugs differently affect cognitive function, and data on the effect of single-pill combination (SPC) of antihypertensive drugs on cognitive function are presented only in single studies.

Aim. To investigate the impact of amlodipine/valsartan SPC (A/V SPC) on blood pressure (BP) level and cognitive functions in the middle-aged antihypertensive treatment-naive patients with stage II grade 1-2 essential arterial hypertension.

Methods. A group of patients with stage II grade 1-2 essential arterial hypertension who had not previously received regular antihypertensive treatment (n=38, age 49.7±7.0 years) was retrospectively formed. All the patients were treated with A/V SPC and all of them achieved target office BP (less than 140/90 mm Hg). And after 12-week follow-up (since the time of reaching the target BP) the antihypertensive treatment efficacy assessment using ambulatory BP monitoring (ABPM) were performed in all included hypertensive patients. Age-matched healthy people with normal BP (n=20, mean age 45.4±5.1years) represented a control group. In all participants cognitive functions were evaluated by 5 different tests at baseline and at the end of follow-up: Montreal Cognitive Assessment (MoCA); Trail Making test (part A and part B), Stroop Color and Word Test; verbal fluency test; 10-item word list learning task. Baseline Hamilton depression and anxiety rating scale data were also available in all individuals.

Results. According to the ABPM data 24-hour, day-time and night-time systolic, diastolic and pulse BP significantly decreased after the treatment with A/V SPC (p<0.001 for systolic and diastolic BP and p<0.01 for pulse BP). After the treatment with A/V SPC significantly improved results of cognitive tests in hypertensive patients: decreased time in Trail Making Test part B (from 114.7±37.0 to 96.3±26.5 s; р=0.001); time difference between part B and part A of Trail Making Test (from 75.2±32.8 to 57.7±20.1 s; р=0.002); time in Stroop test part 3 (from 117.0±28.1 to 108.0±28.4 s; р=0.013); and interference score (from 50.9±19.2 to 43.1±22.0 s; р=0.011); increased MoCA score (from 28.4±1.3 to 29.4±1.2; р=0.001); as well as increased the 10-item word list learning task – immediate recall (from 5.7±1.3 to 6.5±1.2 words; р=0.001); 10-item word list learning task – delayed recall (from 6.3±2.1 to 6.9±1.7 words; р=0.006); literal fluency (from 11.7±3.4 to 13.2±3.2 words; р=0.020) and categorical fluency (from 7.3±2.5 to 9.5±2.9 words; p<0.001). In control group at the end of follow-up compared to baseline significantly increased the 10-item word list learning task – immediate recall (from 5.8±0.9 to 6.6±1.1 words; р<0.05) and delayed recall (from 5.9±1.8 to 8.2±1.4 words; р<0.001).

Conclusion. In retrospective analysis improvement of cognitive function was found in middle-aged patients with hypertension, taking A/V SPC for 12 weeks after reaching the target BP. 

About the Authors

O. D. Ostroumova
Pirogov Russian National Research Medical University; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Head of Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center, Ostrovitianova ul. 1, Moscow, 117997;

MD, PhD, Professor, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Trubetskaya ul. 8-2, Moscow, 119991



E. V. Borisova
A.I. Evdokimov Moscow State University of Medicine and Dentistry; E.O. Mukhin Municipal Clinical Hospital
Russian Federation

External PhD Student, Chair of Therapy and Occupational Diseases, Delegatskaya ul. 20/1, Moscow, 127473;

MD, Cardiologist, Cardiology Department №1, Federativnii prospect 17, Moscow, 111399



A. I. Kochetkov
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Researcher, Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center, 

Ostrovitianova ul. 1, Moscow, 117997



T. M. Ostroumova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, Post-Graduate Student, Chair of Nervous Diseases and Neurosurgery, 

Trubetskaya ul. 8-2, Moscow, 119991



O. V. Bondarec
A.I. Evdokimov Moscow State University of Medicine and Dentistry
Russian Federation

MD, PhD, Associate Professor, Chair of Therapy and Occupational Diseases,

Delegatskaya ul. 20/1, Moscow, 127473



References

1. Gasecki D., Kwarciany M., Nyka W., Narkiewicz K. Hypertension, brain damage and cognitive decline. Curr Hypertens Rep. 2013;15(6):547-58. doi:10.1007/s11906-013-0398-4.

2. Towards a dementia plan: a WHO guide. Geneva: World Health Organization; 2018. [cited by Feb 02, 2019]. Available from: http://apps.who.int/iris/handle/10665/272642.

3. Fitri F.I., Rambe A.S. Correlation between hypertension and cognitive function in elderly. IOP Conference Series: Earth and Environmental Science. 2018;125(1):012177. doi:10.1088/1755-1315/125/1/012177.

4. Parfenov V.A. Diagnosis and treatment of chronic cerebral ischemia, the results of the study “DIAMOND”. Meditsinskii Sovet. 2018; 9: 8-12 (In Russ.)

5. Iadecola C., Yaffe K., Biller J. et al. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension. 2016;68(6):e67-e94. doi:10.1161/HYP.0000000000000053.

6. Walker K.A, Power M.C., Gottesman R.F. Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review. Curr Hypertens Rep. 2017;19(3):24. doi:10.1007/s11906-017-0724-3.

7. Williams B., Mancia G., Spiering W. et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339.

8. Zheleznykh, E.A., Danilogorskaya, Yu.A., Privalova, E.V. et al. Effect of combined antihypertensive therapy with indapamide and perindopril on the morphofunctional parameters of the heart, small and medium caliber vessels and cognitive function in patients with hypertensive disease. Kardiologiia. 2016;(3):19-24 (In Russ.)

9. Fogari R., Mugellini A., Zoppi A. et al. Effect of telmisartan/hydrochlorothiazide vslisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J Hum Hypertens. 2006;20(3):177-85. doi:10.1038/sj.jhh.1001964.

10. O’Brien E., Parati G., Stergiou G. et al. European Society of Hypertension Working Group on Blood Pressure Monitoring. J Hypertens. 2013;31:1731-68. doi:10.1097/HJH.0b013e328363e964.

11. Nasreddine Z.S., Phillips N.A., Bedirian V. et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695-9. doi:10.1111/j.1532-5415.2005.53221.x.

12. Nasreddine Z. MoCA Russian version, 2010. [cited by Feb 02, 2019]. Available from: http://www.mocatest.org/wp-content/uploads/2015/tests-instructions/MoCA-TestRussian_2010.pdf

13. Morris J.C., Heyman A., Mohs R.C. et al. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989;39:1159-65.

14. Parfenov V.A., Zaharov V.V., Preobrazenskaya I.S. Cognitive impairment. Moscow: Remedium; 2014. (In Russ.)

15. Reitan R. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271-6.

16. MacLeod C.M. Half a century of research on the Stroop effect: An integrative review. Psychol Bull. 1991;109(2):163-203.

17. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5.

18. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 196023:56-62.

19. Lithell H., Hansson L., Skoog I. et al. The study on cognition and prognosis in the elderly (SCOPE). Principal results of a randomised double-blind intervention trial. J Hypertens. 2003;21:875-86. doi:10.1097/01.hjh.0000059028.82022.89.

20. Ostroumova T.M., Parfenov V.A., Ostroumova O.D., Borisova E.V. Effect of indapamide/perindopril fixed-dose combination on 24-hour blood pressure and cognitive functions in treatment-naive middle-aged patients with essential arterial hypertension. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):19-28. (In Russ.) doi:10.14412/2074-2711-2018-3-19-28.

21. Levi Marpillat N., Macquin-Mavier I., Tropeano A.I. et al. Antihypertensive classes, cognitive decline andincidence of dementia: a network meta-analysis. Journal of Hypertension. 2013;31(6):1073- 82. doi:10.1097/HJH.0b013e3283603f53.

22. Nevado-Holgado A.J., Kim C.H., Winchester L. et al. Commonly prescribed drugs associate with cognitive function: a cross-sectional study in UK Biobank. BMJ Open. 2016;6:e012177. doi:10.1136/bmjopen-2016-012177.

23. Zueva I.B., Vanayeva K.I., Sanets E.L., Moroshkina N.V. The effect of antihypertensive therapy on cognitive disorders in patients with arterial hypertension and obesity. Arterial Hypertension. 2012;8(4):326-33 (In Russ.)

24. Ilov N.N., Shvarts R.N., Panova T.N. Cognitive-mnestic functions in able-bodied aged patients with essential arterial hypertension in amlodipine treatment. Rational Pharmacotherapia in Cardiology. 2011;7(3):313-8. (In Russ.)

25. Katada E., Uematsu N., Takuma Y., Matsukawa N. Comparison of effects of valsartan and amlodipine on cognitive functions and auditory p300 event-related potentials in elderly hypertensive patients. Clin Neuropharmacol. 2014;37(5):129-32. doi:10.1097/WNF.0000000000000042.

26. Hanyu H., Hirao K., Shimizu S. et al. Favourable effects of nilvadipine on cognitive function and regional cerebral blood flow on SPECT in hypertensive patients with mild cognitive impairment. Nucl Med Commun. 2007;28(4):281-7. doi:10.1097/MNM.0b013e32804c58aa.

27. Fogari R., Mugellini A., Zoppi A. et al. Effects of valsartan compared with enalapril on blood pressure and cognitive function in elderly patients with essential hypertension. Eur J Clin Pharmacol. 2004;59(12):863-8. doi:10.1007/s00228-003-0717-9.

28. Braszko J. The contribution of AT1 and AT2 angiotensin receptors to its cognitive effects. Acta Neirobiol Exp. 1996;56:49-54.

29. Wright J.W., Harding J.W. The angiotensin AT4 receptor subtype as a target for the treatment of memory dysfunction associated with Alzheimers disease. J Renin Angiotensin Aldosterone Syst. 2008;9:226-37. doi:10.1177/1470320308099084.

30. Nation D.A., Ho J., Yew B. Alzheimer’s Disease Neuroimaging Initiative. Older Adults Taking AT1- Receptor Blockers Exhibit Reduced Cerebral Amyloid Retention. J Alzheimers Dis. 2016;50(3):779- 89. doi:10.3233/JAD-150487.

31. Gorelick P.B., Nyenhuis D. American Society of Hypertension Writing Group. Blood pressure and treatment of persons with hypertension as it relates to cognitive outcomes including executive function. J Am Soc Hypertens. 2012;6(5):309-15. doi:10.1016/j.jash.2012.08.004.

32. Trompet S., Westendorp R.G., Kamper A.M. de Craen A.J. Use of calcium antagonists and cognitive decline in old age. The Leiden 85-plus study. Neurobiol Aging. 2008;29(2):306-8. doi:10.1016/j.neurobiolaging.2006.10.006.

33. Tsareva V.M, Hozjainova N.J., Bezaltynnyh M.S. et al. Amlodipine advantages in arterial hypertension therapy. Rational Pharmacotherapy in Cardiology. 2008;5:53-6. (In Russ.) doi:10.20996/1819-6446-2008-4-5-53-56.

34. Rouch L., Cestac P., Hanon O. et al. Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs. 2015;29(2):113-30. doi:10.1007/s40263-015-0230-6.

35. Berridge M.J. Calcium signalling and Alzheimer’s disease. Neurochem Res. 2011;36(7):1149-56. doi:10.1007/s11064-010-0371-4.

36. Thibault O., Gant J.C., Landfield P.W. Expansion of the calcium hypothesis of brain aging and Alzheimer’s disease: minding the store. Aging Cell. 2007;6(3):307-17. doi:10.1111/j.1474-9726.2007.00295.x.

37. Pierrot N., Ghisdal P., Caumont A-S, Octave J-N. Intraneuronal amyloid-beta1-42 production triggered by sustained increase of cytosolic calcium concentration induces neuronal death. J Neurochem. 2004;88(5):1140-50. doi:10.1046/j.1471-4159.2003.02227.x.

38. Querfurth H.W., Selkoe D.J. Calcium ionophore increases amyloid beta peptide production by cultured cells. Biochemistry (Mosc). 1994;33(15):4550-61.

39. Mattson M.P. Antigenic changes similar to those seen in neurofibrillary tangles are elicited by glutamate and Ca2? influx in cultured hippocampal neurons. Neuron. 1990;4(1):105-17. doi:10.1016/0896-6273(90)90447-N


For citation:


Ostroumova O.D., Borisova E.V., Kochetkov A.I., Ostroumova T.M., Bondarec O.V. Improving the cognitive functions in the middle-aged patients with essential arterial hypertension after the treatment with amlodipine/valsartan single-pill combination. Rational Pharmacotherapy in Cardiology. 2019;15(1):54-62. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-1-54-62

Views: 190


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)