Cognitive performance was measured by the Mini-Mental State Examination (MMSE). Patients with DTTH had a significantly lower mean baseline score (26.5±3.6) versus the non-DTTH group (27.1±3.4; P<0.001 by ANOVA). After six months, the overall mean MMSE score for the DTTH patients was 27.5±3.0, with an average increment of 0.96±2.05 versus baseline (P<0.001). Among non-DTTH patients, the MMSE increment was similar, approximately 0.79±1.79.4

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The study authors concluded that patients with DTTH who received EBT achieved a significant reduction in arterial BP and an increase in their average MMSE score. They theorized that anti-hypertensive medications whose mechanism of actions affect the renin-angiotensin system may be able to prevent, delay, or slow the onset/progression of cognitive decline. They acknowledged that their definition of DTTH was a “pragmatic definition chosen to facilitate a retrospective investigation” and not equivalent to resistant hypertension.They also noted that the DTTH prevalence of 11.5% in OSCAR was lower than most current estimates, especially in the United States.5 In addition, while the study authors were cautious about the average 1-point increase in MMSE score, they did note that it occurred over a short period (six months), and that other studies with DTTH patients without EBT tended to show lower MMSE scores at trial end. They theorized that lower SBP appeared to be the key to any improvement in cognitive performance. Finally, the study authors stressed that their findings were primarily “an indication of the need for further prospective investigation of the possible relation of anti-hypertension therapy and longer-term trends in cognitive function.”

REFERENCES

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2.       Roberie DR, Elliott WJ. What is the prevalence of resistant hypertension in the United States? CurrOpin Cardiol. 2012;27:386-391.

3.       Hanon O, Berrou JP, Negre-Pages L, et al. Effects of hypertension therapy based on eprosartan on systolic arterial blood pressure and cognitive function: primary results of the Observational Study on Cognitive function And Systolic Blood Pressure Reduction open-label study. J Hypertens. 2008;26:1642-1650.

4.       Petrella RJ, Shlyakhto E, Konradi AO, Berrou JP, Sedefdjian A, Pathak A; OSCAR Publication Group. Blood pressure responses to hypertension treatment and trends in cognitive function in patients with initially difficult-to-treat hypertension: a retrospective subgroup analysis of the Observational Study on Cognitive Function and SBP Reduction (OSCAR) study. J Clin Hypertens (Greenwich). 2012;14:78-84.

5.       Calhoun DA, Jones D, Textor S, et al; American Heart Association Professional Education Committee. Resistant hypertension:diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation.2008;117:e510-e526.