[Ramipril in elderly patients with mild and moderate hypertension. Clinical efficacy, effect on cerebral blood flow...

to study different ramipril dosage regimens on cerebral blood flow and cognitive function in elderly patients with mild to moderate hypertension.

30 out-patient hypertensive patients (13 men, 17 women, age 55-75 years, mean 62+1,5).

After withdrawal of previous antihypertensive therapy patients were randomized to receive gradual (group 1) and more active (group 2) ramipril regimen. The starting dose (2,5 mg in group 1 and 5 mg in group 2) was increased at 2-week intervals to 10 mg daily. If target blood pressure (BP) level was not achieved hydrochlorothiazide (25 mg/day) was added. The treatment duration was 8 weeks. 24-hour BP monitoring, duplex scanning of brachiocephalic arteries were performed at baseline, after the first dose of ramipril, and after 8 weeks of therapy. Intellectual functioning was evaluated with 4 tests of memory and attention assessment.

Both single dose and long term ramipril treatment provided stable and steady hypertensive effect throughout 24 hours. There was no case of first dose hypotension in elderly patients. Both starting doses (2,5 mg and 5 mg) were similarly safe. Neither first dose of ramipril nor long term treatment caused impairment of cerebral blood flow. 8-week ramipril treatment in elderly hypertensive patients was associated with improvement of some characteristics of intellectual functioning.