Skinner M H, Futterman A, Morrissette D, Thompson L W, Hoffman B B, Blaschke T F
Stanford University Medical Center, California.
Ann Intern Med. 1992 Apr 15;116(8):615-23. doi: 10.7326/0003-4819-116-8-615.
To compare the effects of atenolol and nifedipine on mood and cognitive function in elderly hypertensive patients.
Randomized, double-blind, crossover trial.
Thirty-one elderly volunteers (7 women and 4 men) 60 to 81 years of age with mild to moderate hypertension were recruited from the general community and a Veterans Affairs hospital hypertension clinic. Six volunteers withdrew at early phases of the study for reasons unrelated to adverse drug effects.
Participants had 2 weeks of placebo, to 6 weeks of titration with atenolol or nifedipine, and weeks of treatment followed by similar periods with the other drug.
Psychometric tests designed to assess mood and cognitive function.
In the group first treated with nifedipine, the summed recall score on the Buschke selective reminding test (a test of verbal learning and memory) decreased by 9.3 words (95% CI, 2.8 to 15.6 words), or 0%, during nifedipine treatment compared with placebo (P = 0.031). The group first treated with atenolol showed no improvement in summed recall scores when results seen during atenolol therapy and placebo administration were compared (P = 0.10); however, this group had an improvement of 16.1 words (CI, 5.6 to 26.5 words), or of 16%, when the atenolol score was compared with the nifedipine score (P = 0.026). In the group first treated with nifedipine, 6 of 11 patients 55%) showed a decrease of 5 words or more during nifedipine therapy compared with placebo, whereas only 1 of the 14 patients (7%) in the group first treated with atenolol showed a similar decrease (P less than 0.01). On the digit symbol test (a psychomotor test), patients treated first with atenolol tended to improve, whereas patients treated first with nifedipine tended to decline. The difference between nifedipine and atenolol, in terms of the change from the score seen during placebo, was 4.3 codings (CI, 0.7 to 7.9 codings) or 10% (P = 0.043). No statistically significant differences were seen between nifedipine and atenolol therapy regarding the other measures of psychomotor ability, sustained attention, motor performance, verbal fluency, or abstract reasoning, and no effects of either drug on mood or psychopathologic symptoms were noted.
Although atenolol and nifedipine are generally free of gross effects on cognition or mood, nifedipine may subtly impair learning and memory in some elderly hypertensive patients.
比较阿替洛尔和硝苯地平对老年高血压患者情绪和认知功能的影响。
随机、双盲、交叉试验。
从普通社区和一家退伍军人事务医院高血压诊所招募了31名年龄在60至81岁之间的老年志愿者（7名女性和4名男性），患有轻度至中度高血压。6名志愿者在研究早期因与药物不良反应无关的原因退出。
参与者先服用2周安慰剂，然后用阿替洛尔或硝苯地平进行6周滴定，之后用另一种药物进行数周治疗。
旨在评估情绪和认知功能的心理测量测试。
在首先接受硝苯地平治疗的组中，与安慰剂相比，在硝苯地平治疗期间，Buschke选择性提醒测试（一种言语学习和记忆测试）的总回忆分数下降了9.3个单词（95%可信区间，2.8至15.6个单词），即下降了0%（P = 0.031）。当比较阿替洛尔治疗期间和服用安慰剂期间的结果时，首先接受阿替洛尔治疗的组总回忆分数没有改善（P = 0.10）；然而，当将阿替洛尔分数与硝苯地平分数进行比较时，该组改善了16.1个单词（可信区间，5.6至26.5个单词），即改善了16%（P = 0.026）。在首先接受硝苯地平治疗的组中，11名患者中有6名（55%）在硝苯地平治疗期间与安慰剂相比总回忆分数下降了5个或更多单词，而在首先接受阿替洛尔治疗的14名患者中只有1名（7%）出现了类似的下降（P小于0.01）。在数字符号测试（一种心理运动测试）中，首先接受阿替洛尔治疗的患者倾向于改善，而首先接受硝苯地平治疗的患者倾向于下降。硝苯地平和阿替洛尔在从安慰剂期间的分数变化方面的差异为4.3个编码（可信区间，0.7至7.9个编码）或10%（P = 0.043）。在心理运动能力、持续注意力、运动表现、言语流畅性或抽象推理的其他测量方面，硝苯地平和阿替洛尔治疗之间没有统计学上的显著差异，并且没有观察到两种药物对情绪或精神病理症状有影响。
虽然阿替洛尔和硝苯地平通常对认知或情绪没有明显影响，但硝苯地平可能会在一些老年高血压患者中轻微损害学习和记忆。
