The Study on COgnition and Prognosis in the Elderly (SCOPE)--recent analyses

Principal results of the Study on COgnition and Prognosis in the Elderly (SCOPE) were published in 2003. Blood pressure reduction was pronounced in both the candesartan and control groups, with little difference. With candesartan-based treatment, compared with control, the relative risk of non-fatal stroke was 0.72 (P = 0.04) and of major cardiovascular events 0.89 (P = 0.19). There were no significant differences in cognitive outcomes. We have reviewed recent subgroup analyses in SCOPE. Cardiovascular endpoints were analysed in patients who did not receive add-on treatment after random allocation to groups (post hoc) and in patients with certain characteristics at baseline, such as age, sex, diabetes, isolated systolic hypertension, or a history of stroke. Cognitive endpoints were analysed in patients with baseline Mini Mental State Examination (MMSE) score 24-28, and in those examined with more extensive investigations than the MMSE. In patients without add-on treatment, there were significant risk reductions in the candesartan group in major cardiovascular events [relative risk (RR) 0.68, 95% confidence interval (CI) 0.51 to 0.92] and mortality (RR 0.73, 95% CI 0.57 to 0.95). In other subgroups, the relative risks for major cardiovascular events and stroke were generally consistent with those in the entire study population. However, risk reductions in the candesartan group were particularly marked in patients with a history of stroke. In patients with MMSE score 24-28 at baseline, the score declined significantly less in the candesartan group (between-group difference 0.49, 95% CI 0.02 to 0.97). Cardiovascular outcome benefit of candesartan-based treatment was most evident in patients without add-on treatment and in those with a history of stroke. Results in other subgroups were generally consistent with those in the entire SCOPE study population. In patients with slightly low cognitive function at baseline, the MMSE score declined less in the candesartan group.