eprosartan and Cognition-Disorders

Hypertension is a common condition associated with considerable morbidity and mortality. Antihypertensive drugs reduce the risk of cardiovascular and cerebrovascular events, and may also be associated with reductions in cognitive decline. Eprosartan is an angiotensin II type 1 receptor antagonist with a unique dual mechanism of action that is approved for the treatment of essential hypertension. In clinical trials, eprosartan has been shown to significantly reduce systolic blood pressure and to be associated with significant reductions in pulse pressure in elderly patients with isolated systolic hypertension. Data suggest that blood pressure reductions achieved with eprosartan in elderly hypertensive patients are also associated with improvements in cognitive function. Eprosartan compares favorably with other classes of antihypertensive agents in terms of reductions in mortality, cardiovascular and cerebrovascular events, and stroke recurrence. Evidence suggests that eprosartan may represent a useful addition to combination drug strategies for the management of hypertensive patients with elevated cardiovascular and cerebrovascular risk.

Topics: Acrylates; Angiotensin II Type 1 Receptor Blockers; Blood Pressure; Blood Pressure Determination; Cardiovascular Diseases; Cognition Disorders; Female; Humans; Hypertension; Imidazoles; Male; Sensitivity and Specificity; Severity of Illness Index; Stroke; Survival Analysis; Systole; Thiophenes; Treatment Outcome

Given the ageing population, dementia is an ever-increasing health burden. A positive correlation between cognitive decline or dementia and blood pressure levels has been indicated. There is, however, conflicting evidence over the definitive link between the use of antihypertensives and the subsequent reduction of cognitive decline. The specific use of angiotensin II receptor blockers (ARBs) in preventing vascular dementia has been investigated with eprosartan treatment. In animal studies utilising stroke-prone rats, eprosartan has been shown to reduce end-organ damage of the heart and kidneys in a study assessing cardiomyopathy and renal failure. The Morbidity and mortality after Stroke, Eprosartan compared with nitrendipine for Secondary prevention (MOSES) study, assessing 1405 patients, has shown the cerebroprotective effects of eprosartan compared with the calcium channel blocker nitrendipine. In this study, however, no change in cognitive function, as assessed by the mini-mental status examination (MMSE) score, was seen between the treatment groups. The Observational Study on Cognitive function And systolic blood pressure Reduction (OSCAR) trial, including more than 60,000 hypertensive patients, also assessed the ability of eprosartan to alter the MMSE score. In contrast to the MOSES trial, preliminary data from 10,000 patients after 6 months of treatment identified a decrease in blood pressure alongside a significant increase in MMSE score. Specific subpopulations within this study, including the elderly, patients with higher initial systolic blood pressure and patients with a body mass index (BMI) of 25-30 kg/m2 showed the greatest change in MMSE score. These data indicate an association with blood pressure reduction and improvement of cognitive function with eprosartan treatment.

Topics: Acrylates; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers; Animals; Cognition Disorders; Dementia, Vascular; Female; Humans; Hypertension; Imidazoles; Male; Middle Aged; Neuropsychological Tests; Rats; Stroke; Thiophenes

Recent studies have indicated a relationship between hypertension and cognitive function but therapeutic trials of antihypertensive therapy on the prevention of cognitive disorders have produced controversial findings.. The Observational Study on Cognitive function And Systolic Blood Pressure Reduction is an open-label trial in 28 countries designed to evaluate the impact of eprosartan-based therapy on cognitive function. The Mini-Mental State Examination was used as a global tool for the comprehensive assessment of cognitive function, with an intention to treat a cohort of 25 745 hypertensive patients aged at least 50 years during a follow-up interval of 6 months. Blood pressure therapy was initiated with eprosartan 600 mg/day with provision for additional medication to be introduced after 1 month in patients with insufficient blood pressure response.. Use of eprosartan, either as monotherapy or in combination regimens, was associated with a substantial reduction in arterial blood pressure from 161.9/93.1 mmHg at baseline to 136.1/80.8 mmHg at 6 months (P < 0.0001). The overall mean Mini-Mental State Examination score at completion of follow-up was 27.9 +/- 2.9 compared with 27.1 +/- 3.4 at baseline (P < 0.0001). A significant correlation was shown between the mean absolute response of Mini-Mental State Examination and the magnitude of systolic blood pressure reduction. At the end of the study, patients with systolic blood pressure less than 140 mmHg had a larger improvement in Mini-Mental State Examination [0.88 +/- 0.01 (SEM)] than those with systolic blood pressure between 140 and 159 mmHg [0.69 +/- 0.02 (SEM); P < 0.001], or than those with systolic blood pressure of at least 160 mmHg [0.38 +/- 0.05 (SEM); P < 0.0001]. Furthermore, cognitive decline was demonstrated in multiple linear regression to be independently associated with age [odds ratio 1.19 (1.14; 1.25)], Mini-Mental State Examination at baseline [odds ratio 1.19 (1.14; 1.25)], systolic blood pressure at baseline [odds ratio 1.20 (1.13; 1.27)] and systolic blood pressure reduction [odds ratio 0.77 (0.73; 0.82)].. The results of the Observational Study on Cognitive function And Systolic Blood Pressure Reduction are supportive of the proposition that antihypertensive therapy based on drugs that target the renin-angiotensin system is associated with preservation of cognitive function.

Topics: Acrylates; Aged; Antihypertensive Agents; Blood Pressure; Cognition; Cognition Disorders; Female; Follow-Up Studies; Humans; Hypertension; Imidazoles; Male; Middle Aged; Neuropsychological Tests; Thiophenes; Treatment Outcome

Given the ageing population, dementia is an ever-increasing health burden. A positive correlation between cognitive decline or dementia and blood pressure levels has been indicated. There is, however, conflicting evidence over the definitive link between the use of antihypertensives and the subsequent reduction of cognitive decline. The specific use of angiotensin II receptor blockers (ARBs) in preventing vascular dementia has been investigated with eprosartan treatment. In animal studies utilising stroke-prone rats, eprosartan has been shown to reduce end-organ damage of the heart and kidneys in a study assessing cardiomyopathy and renal failure. The Morbidity and mortality after Stroke, Eprosartan compared with nitrendipine for Secondary prevention (MOSES) study, assessing 1405 patients, has shown the cerebroprotective effects of eprosartan compared with the calcium channel blocker nitrendipine. In this study, however, no change in cognitive function, as assessed by the mini-mental status examination (MMSE) score, was seen between the treatment groups. The Observational Study on Cognitive function And systolic blood pressure Reduction (OSCAR) trial, including more than 60,000 hypertensive patients, also assessed the ability of eprosartan to alter the MMSE score. In contrast to the MOSES trial, preliminary data from 10,000 patients after 6 months of treatment identified a decrease in blood pressure alongside a significant increase in MMSE score. Specific subpopulations within this study, including the elderly, patients with higher initial systolic blood pressure and patients with a body mass index (BMI) of 25-30 kg/m2 showed the greatest change in MMSE score. These data indicate an association with blood pressure reduction and improvement of cognitive function with eprosartan treatment.

Topics: Acrylates; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers; Animals; Cognition Disorders; Dementia, Vascular; Female; Humans; Hypertension; Imidazoles; Male; Middle Aged; Neuropsychological Tests; Rats; Stroke; Thiophenes

Data from several recent clinical trials have suggested a beneficial effect of antihypertensive medications on preservation of cognitive function. Eprosartan, an angiotensin type-1 receptor antagonist (ARA) with dual action on both pre- and postsynaptic angiotensin type 1 receptors, may be effective in the control of SBP and the prevention of cognitive decline. The OSCAR (Observational Study on Cognitive function And SBP Reduction) study is an international longitudinal observational study with a duration of 6 months intended to examine the impact of the ARA eprosartan on cognitive function (assessed using the Mini-Mental State Examination [MMSE]) and control of systolic blood pressure (SBP) in a large international population of hypertensive patients managed in a standard primary care setting. A total of 100,000 hypertensive patients, aged >or=50 years and with SBP of >140 mmHg will be recruited by more than 20 000 primary care physicians in 27 countries. These patients will receive eprosartan 600 mg once a day for 6 months. The MMSE, a globally validated cognitive screening test, will be performed at baseline, and after 6 months of treatment. After the first month of monotherapy, eprosartan treatment may, at the absolute discretion of individual investigators, be supplemented with other antihypertensive medications for the remainder of the study. The primary outcome indices are the mean relative change in MMSE score and the absolute change from baseline in SBP in the study population as a whole and in subsets of patients according to various factors among them: ethnicity, comorbidities (i.e. target organ damage, diabetes), baseline cognitive level and baseline blood pressure level. The secondary objectives are to identify factors influencing SBP and MMSE changes. The OSCAR trial is the first international observational study focusing on MMSE in a wide international cohort of hypertensive patients. The results are expected in 2007.

Topics: Acrylates; Angiotensin II Type 1 Receptor Blockers; Antihypertensive Agents; Blood Pressure; Cognition; Cognition Disorders; Female; Humans; Hypertension; Imidazoles; Longitudinal Studies; Male; Middle Aged; Multicenter Studies as Topic; Neuropsychological Tests; Observation; Patient Selection; Receptor, Angiotensin, Type 1; Research Design; Thiophenes