Study on COgnition and Prognosis in the Elderly (SCOPE): Design and Objectives

Area of Science:

• Gerontology
• Cardiovascular Medicine
• Neurology

Background:

• Hypertension is a significant risk factor for stroke, cognitive impairment, and dementia in the elderly.
• The protective effects of treating mild hypertension (diastolic blood pressure 90-99 mmHg) in older adults against cardiovascular events and cognitive decline remain unclear.

Purpose of the Study:

• To evaluate the efficacy of candesartan cilexetil versus placebo in preventing major cardiovascular events and cognitive impairment in elderly patients with mild hypertension.
• To assess the impact of antihypertensive treatment on quality of life and health economics in this demographic.

Main Methods:

• The Study on COgnition and Prognosis in the Elderly (SCOPE) was a prospective, randomized, double-blind, placebo-controlled trial.
• Nearly 5000 elderly patients (70-89 years) with mild hypertension were randomized to receive candesartan cilexetil or placebo.
• Participants were followed for a mean of 2.5 years, with assessments including blood pressure, Mini-Mental State Examination (MMSE), and cardiovascular events.

Main Results:

• Candesartan cilexetil significantly reduced the incidence of stroke compared to placebo (hazard ratio 0.67; 95% confidence interval 0.49–0.91).
• No significant differences were observed between groups for other major cardiovascular events (myocardial infarction, cardiovascular death) or overall cognitive decline.
• The treatment was generally well-tolerated, with a tolerability profile similar to placebo.

Conclusions:

• Antihypertensive treatment with candesartan cilexetil in elderly patients with mild hypertension is effective in reducing stroke incidence.
• While not impacting overall cognitive decline, the study provides valuable insights into managing cardiovascular risk in older adults.