Comparative study of pharmacological correction strategies for moderate cognitive impairment in hypertensive patients

Objective: to investigate the prevalence of cognitive impairment (CI) and possibilities of its pharmacological correction in hypertensive patients, by comparatively evaluating the efficiency of different treatment options: antihypertensive therapy and its combinations with vasoactive drugs and the dopamine receptor agonist piribedil.

Patients and methods. At the first stage of the investigation, the prevalence of CI was assessed in a continuous sample of hypertensive patients (n=350). The second stage included a naturalistic comparative study of the efficiency of various therapeutic strategies for moderate CI (MCI) in patients with Stage 1–2 hypertension (n=91). This investigation lasted 48 weeks and consisted of a 24-week treatment period and a 24-weeks follow-up period.

Results and discussion. CI was diagnosed in 83.4% of patients in the continuous sample, while it reached the level of dementia in 16.9%. Therapy aimed at achieving and maintaining blood pressure (BP) targets did not lead to the regression of MCI. However, BP correction in combination with a 24-week piribedil therapy cycle was optimal in patients with CI. By the end of treatment, the Montreal Cognitive Assessment (MoCa) scores increased from 24.5Ѓ}0.8 to 27.5Ѓ}0.6 (p<0.05) and from 24.9Ѓ}0.7 to 27.1Ѓ}0.8 (p<0.05) in the groups of patients randomized to supplemental piribedil alone or in combination with nootropic and/or vascular drugs, respectively. There were no intergroup differences in the groups of patients randomized to supplemental piribedil. The time course of cognitive changes in the further follow-up period showed a longterm positive effect of piribedil on cognitive function.

Conclusion. It is necessary to regularly screen for cognitive dysfunction in hypertensive patients. The most effective treatment in combination with a long-term piribedil therapy cycle for hypertension-associated MCI was to promote the achievement and retention of blood pressure targets.

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