Effect of Discontinuation of Antihypertensive Treatment in Elderly People on Cognitive Functioning--the DANTE Study
Justine E F Moonen1, Jessica C Foster-Dingley1, Wouter de Ruijter2
1Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.
Insights
Discontinuing antihypertensive treatment in elderly individuals with mild cognitive deficits did not improve cognitive or daily functioning. This study found no significant benefits in cognition, mood, or functional status after stopping blood pressure medication.
Area of Science:
- Gerontology
- Neurology
- Clinical Trials
Background:
- Observational studies suggest low blood pressure (BP) may increase cognitive decline risk in the elderly.
- Older individuals are susceptible to impaired cerebral autoregulation, potentially compromising brain blood flow and cognition when BP is lowered.
Purpose of the Study:
- To evaluate if discontinuing antihypertensive treatment in elderly individuals with mild cognitive deficits enhances cognitive, psychological, and daily functioning.
Main Methods:
- A community-based randomized clinical trial involving 385 participants aged 75+ with mild cognitive deficits (Mini-Mental State Examination score 21-27).
- Participants were randomized to either discontinue or continue antihypertensive treatment (1:1 ratio).
- Outcomes included changes in overall cognition, cognitive domains, depression, apathy, functional status, and quality of life at 16-week follow-up.
Main Results:
- Discontinuing antihypertensive treatment led to a significant increase in systolic BP (7.36 mm Hg) and diastolic BP (2.63 mm Hg) compared to continuation.
- No significant differences were observed between the discontinuation and continuation groups in the primary outcome (overall cognition compound score) or secondary outcomes.
- Adverse events were similarly distributed between the intervention and control groups.
Conclusions:
- Discontinuation of antihypertensive treatment in older adults with mild cognitive deficits does not improve cognitive, psychological, or general daily functioning at 16 weeks.
- The findings suggest that current antihypertensive strategies should be maintained in this population to manage BP effectively.
- Further research is needed to understand the long-term effects and optimal BP management in elderly individuals with cognitive impairments.
Importance:
Observational studies indicate that lower blood pressure (BP) increases risk for cognitive decline in elderly individuals. Older persons are at risk for impaired cerebral autoregulation; lowering their BP may compromise cerebral blood flow and cognitive function.
Objective:
To assess whether discontinuation of antihypertensive treatment in older persons with mild cognitive deficits improves cognitive, psychological, and general daily functioning.
Design, Setting, And Participants:
A community-based randomized clinical trial with a blinded outcome assessment at the 16-week follow-up was performed at 128 general practices in the Netherlands. A total of 385 participants 75 years or older with mild cognitive deficits (Mini-Mental State Examination score, 21-27) without serious cardiovascular disease who received antihypertensive treatment were enrolled in the Discontinuation of Antihypertensive Treatment in Elderly People (DANTE) Study Leiden from June 26, 2011, through August 23, 2013 (follow-up, December 16, 2013). Intention-to-treat analyses were performed from January 20 through April 11, 2014.
Interventions:
Discontinuation (n=199) vs continuation (n=186) of antihypertensive treatment (allocation ratio, 1:1).
Main Outcomes And Measures:
Change in the overall cognition compound score. Secondary outcomes included changes in scores on cognitive domains, the Geriatric Depression Scale-15, Apathy Scale, Groningen Activity Restriction Scale (functional status), and Cantril Ladder (quality of life).
Results:
Compared with 176 participants undergoing analysis in the control (continuation) group, 180 in the intervention (discontinuation) group had a greater increase (95% CI) in systolic BP (difference, 7.36 [3.02 to 11.69] mm Hg; P=.001) and diastolic BP (difference, 2.63 [0.34 to 4.93] mm Hg; P=.03). The intervention group did not differ from the control group in change (95% CI) in overall cognition compound score (0.01 [-0.14 to 0.16] vs -0.01 [-0.16 to 0.14]; difference, 0.02 [-0.19 to 0.23]; P=.84). The intervention and control groups did not differ significantly in secondary outcomes, including differences (95% CIs) in change in compound scores of the 3 cognitive domains (executive function, -0.07 [-0.29 to 0.15; P=.52], memory, 0.08 [-0.12 to 0.29; P=.43], and psychomotor speed, -0.85 [-1.72 to 0.02; P=.06]), symptoms of apathy (0.17 [-0.65 to 0.99; P=.68]) and depression (0.14 [-0.20 to 0.48; P=.41]), functional status (-0.72 [-1.52 to 0.09; P=.08]), and quality-of-life score (-0.09 [-0.34 to 0.16; P=.46]). Adverse events were equally distributed.
Conclusions And Relevance:
In older persons with mild cognitive deficits, discontinuation of antihypertensive treatment did not improve cognitive, psychological, or general daily functioning at the 16-week follow-up.
Trial Registration:
trialregister.nl Identifier: NTR2829.
