Division of Geriatric, Hospital, and General Internal Medicine, Department of Medicine, University of Southern California, Los Angeles, CA 90033, USA. ihajjar@usc
J Am Geriatr Soc. 2013 Feb;61(2):194-201. doi: 10.1111/jgs.12100. Epub 2013 Jan 25.
To compare the effects of three antihypertensive medications on cerebral hemodynamic and cognitive function in hypertensive individuals with executive dysfunction.
Double-blind randomized clinical trial.
Community.
Fifty-three individuals aged 60 and older with hypertension and executive dysfunction.
Lisinopril, candesartan, or hydrochlorothiazide for 1 year.
Cerebral blood flow velocity (BFV; transcranial Doppler ultrasonography during rest, sitting, standing, hypercapnia, and hypocapnia), cognition, and blood pressure were measured at baseline and after 6 and 12 months. Linear mixed models were used to compare the three groups.
Of the 53 participants, 47 had successful insonation (mean age 72; 70% white; 57% women). There was a tendency toward an increase in BFV in the candesartan group and a decrease in the lisinopril and hydrochlorothiazide groups (between-group P = .57) that was significant in those with low BFV at baseline (<median 27.6 cm/s, between-group P = .03). The candesartan group also had the greatest improvement in executive function (Trail Making Test Part B improved by 17.1 seconds, vs hydrochlorothiazide improved by 4.2 seconds and lisinopril worsened by 14.4 seconds, P = .008). Carbon dioxide vasoreactivity and vasomotor range declined significantly in the lisinopril (within-group P = .001 for vasoreactivity and .02 for vasomotor range) and hydrochlorothiazide groups (within-group P = .10 and .009, respectively) but not in the candesartan group (within-group P = .25 and .38, respectively; between-group P = .30 and .46, respectively).
Angiotensin receptor blockers may preferentially preserve cerebral hemodynamics and executive function in individuals with executive dysfunction. These findings warrant further investigation in a larger trial.
比较三种降压药物对伴有执行功能障碍的高血压患者脑血流动力学和认知功能的影响。
双盲随机临床试验。
社区。
53 名年龄在 60 岁及以上的高血压合并执行功能障碍患者。
依那普利、坎地沙坦或氢氯噻嗪治疗 1 年。
在基线、6 个月和 12 个月时测量脑血流速度（BFV；经颅多普勒超声在休息、坐立、站立、高碳酸血症和低碳酸血症期间）、认知和血压。使用线性混合模型比较三组。
53 名参与者中，47 名成功进行了探测（平均年龄 72 岁；70%为白人；57%为女性）。坎地沙坦组 BFV 有升高趋势，依那普利组和氢氯噻嗪组则降低（组间 P =.57），基线时 BFV 较低者（<中位数 27.6cm/s，组间 P =.03）差异显著。坎地沙坦组在执行功能方面的改善也最大（Trail Making Test 部分 B 提高 17.1 秒，而氢氯噻嗪组提高 4.2 秒，依那普利组恶化 14.4 秒，P =.008）。依那普利组（血管反应性内组 P =.001，血管运动范围内组 P =.02）和氢氯噻嗪组（血管反应性内组 P =.10，血管运动范围内组 P =.009）的二氧化碳血管反应性和血管运动范围显著下降，但坎地沙坦组无显著变化（血管反应性内组 P =.25，血管运动范围内组 P =.38；组间 P =.30，血管运动范围内组 P =.46）。
血管紧张素受体阻滞剂可能优先保护伴有执行功能障碍的个体的脑血流动力学和执行功能。这些发现需要在更大的试验中进一步研究。
