Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

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

https://doi.org/10.14412/2074-2711-2019-2-52-59

Full Text:

Abstract

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.

About the Authors

O. V. Vorobyeva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Olga Vladimirovna Vorobyeva

8, Trubetskaya St., Build. 2, Moscow 119991



Zh. M. Sizova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

8, Trubetskaya St., Build. 2, Moscow 119991



L. M. Bogatyreva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

8, Trubetskaya St., Build. 2, Moscow 119991



References

1. Di Bari M, Pahor M, Franse LV, et al. Dementia and disability outcomes in large hypertension trials: lessons learned from the Systolic Hypertension in the Elderly Program (SHEP) trial. Am J Epidemiol. 2001 Jan 1; 153(1):72-8.

2. Petrovitch H, White LR, Izmirilian G, et al. Midlife blood pressure and neuritic plaques, neurofibrillary tangles, and brain weight at death: the HAAS. Honolulu-Asia aging Study. Neurobiol Aging. 2000 Jan-Feb;21(1):57-62.

3. Forette F, Seux ML, Staessen JA, et al. Prevention of dementia in randomized doubleblind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet. 1998 Oct 24; 352(9137):1347-51.

4. Iadecola C, Yaffe K, Biller J, et al. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension. 2016 Dec;68(6):e67-e94. Epub 2016 Oct 10.

5. Fazekas F, Chawluk JB, Alavi A, et al. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol. 1987 Aug;149(2):351-6.

6. Zakharov VV. AllRussian program of epidemiology research and therapy of cognitive disorders in the elderly («Prometheus»). Nevrologicheskii zhurnal. 2006;11(2):27–32. (In Russ.).

7. Elias PK, Elias MF, Robbins MA, Budge MM. Blood pressure-related cognitive decline: does age make a difference? Hypertension. 2004 Nov; 44(5):631-6. Epub 2004 Oct 4.

8. Levine DA, Galecki AT, Langa KM, et al. Blood Pressure and Cognitive Decline Over 8 Years in Middle-Aged and Older Black and White Americans. Hypertension. 2019 Feb; 73(2):310-318. doi: 10.1161/HYPERTENSIONAHA.118.12062.

9. Li XF, Cui LM, Sun DK, et al. The correlation between cognitive impairment and ambulatory blood pressure in patients with cerebral small vessel disease. Eur Rev Med Pharmacol Sci. 2017 Jul;21(3 Suppl):52-56.

10. Nagaraja D, Jayashree S. Randomized study of the dopamine receptor agonist piribedil in the treatment of mild cognitive impairment. Am J Psychiatry. 2001 Sep;158(9):1517-9.

11. Yakhno NN, Zakharov VV, Strachunskaya EYa, et al. Treatment of non-dement cognitive impairment in patients with hypertension and cerebral atherosclerosis (According to the Russian multicenter study «FUETE»). Nevrologicheskii zhurnal. 2012;17(4):49-55. (In Russ.).


For citation:


Vorobyeva O.V., Sizova Z.M., Bogatyreva L.M. Comparative study of pharmacological correction strategies for moderate cognitive impairment in hypertensive patients. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2):52-59. (In Russ.) https://doi.org/10.14412/2074-2711-2019-2-52-59

Views: 74


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)