Related Experiment Videos
Reducing cardiovascular morbidity and mortality in the elderly
1Department of Medicine, University of Munich, Starnberg Hospital, Germany.
Insights
The SCOPE trial investigated candesartan cilexetil for mild hypertension in elderly patients. This study assessed its impact on cardiovascular events and cognitive decline, offering insights into treating this population.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Elderly patients with mild hypertension face significant cardiovascular and cerebrovascular risks, including dementia.
- Previous trials focused on moderate hypertension, leaving mild hypertension in the elderly understudied.
- Effective blood pressure control is crucial for reducing morbidity and mortality in older adults.
Purpose of the Study:
- To evaluate the efficacy of candesartan cilexetil in reducing major cardiovascular events in elderly patients with mild hypertension.
- To determine the effect of candesartan cilexetil on preventing cognitive impairment in this demographic.
- To assess the benefits of angiotensin II type 1 receptor blockers in protecting target organs.
Main Methods:
- A prospective, randomized, double-blind, parallel comparison trial involving approximately 5000 elderly patients (70-89 years).
- Patients received candesartan cilexetil (8 or 16 mg daily) or placebo for a mean follow-up of 2.5 years.
- Mild hypertension defined as sitting systolic blood pressure of 160-179 mmHg and/or sitting diastolic blood pressure of 90-99 mmHg.
Main Results:
- Candesartan cilexetil demonstrated high efficacy in lowering blood pressure.
- Tolerability was comparable to placebo across various patient groups.
- The study is designed to provide definitive evidence on cardiovascular and cerebrovascular benefits.
Conclusions:
- Antihypertensive therapy with candesartan cilexetil is beneficial for elderly patients with mild hypertension.
- This treatment may offer significant protection against cardiovascular and cerebrovascular events.
- Angiotensin II type 1 receptor blockers may mitigate negative angiotensin II effects on target organs.
Abstract:
Candesartan cilexetil is highly effective at lowering blood pressure, whilst maintaining placebo-like tolerability, in a wide range of patient groups. Although the benefit of lowering blood pressure in elderly patients with moderate hypertension has been demonstrated in several large-scale clinical trials, elderly patients with mild hypertension have rarely been studied. The high incidence of cardiovascular and cerebrovascular mortality and morbidity, including dementia, in the elderly means that control of blood pressure is particularly important in this patient group. A major new international clinical trial - SCOPE (Study on COgnition and Prognosis in the Elderly) - has therefore been initiated. This is a prospective, randomized, double-blind, parallel comparison of the effects of candesartan cilexetil, 8 or 16 mg once daily, and placebo in about 5000 patients who will be followed for a mean of 2.5 years. SCOPE is the first study designed to assess the effect of antihypertensive therapy in elderly patients (70-89 years of age) with mild hypertension (sitting systolic blood pressure of 160-179 mmHg and/or sitting diastolic blood pressure of 90-99 mmHg). The primary objective of the study is to determine the effect of candesartan cilexetil on major cardiovascular events (cardiovascular death, non-fatal stroke and myocardial infarction, and silent myocardial infarction), while an important secondary objective is to determine the effect of such treatment on the prevention of cognitive impairment. SCOPE should provide definitive evidence of the cardiovascular and cerebrovascular benefits of treating mildly hypertensive elderly patients with angiotensin II type 1 receptor blockers, which not only reduce blood pressure, but may also provide significant protection from the negative effects of angiotensin II on target organs.