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Candesartan Effectively Reduces
Blood Pressure in Elderly Hypertensives
A DGReview of :"The Study on Cognition
and Prognosis in the Elderly (SCOPE): principal results of a randomized
double-blind intervention trial"
By
David Loshak
Doctor's Guide, NY - May 12, 2003
Treatment with the angiotensin II receptor blocker candesartan reduces
blood pressure in elderly hypertensive patients slightly more effectively
than placebo.
Although the reduction is not statistically significant, the candesartan-based
treatment was associated with a modest reduction in major cardiovascular
events and a marked decrease in non-fatal stroke in the Study on Cognition
and Prognosis in the Elderly (SCOPE).
Although it is now well known that elderly patients with hypertension
benefit from blood pressure reduction, research has until now not
established the benefits in those whose blood pressure is mildly to
moderately elevated.
Researchers in Sweden, The Netherlands, Germany and Italy designed the
SCOPE study to determine if candesartan would reduce cardiovascular
events, cognitive decline and dementia in such patients.
The double-blind, randomised, parallel-group study enrolled 4,964 patients
aged 70-89 years attending 527 centres in 15 countries who were randomised
to receive candesartan or placebo, plus open-label active anti-hypertensive
treatment as needed.
At enrolment, these patients had systolic blood pressures of 160-179 mm Hg
and/or diastolic blood pressures of 90-99 mmHg. They also had Mini Mental
State Examination test scores of at least 24.
Active anti-hypertensive treatment was given to most patients (84%) in the
control group. Mean follow-up was 3.7 years.
Blood pressure fell by 21.7/10.8 mm Hg in the candesartan group compared
with 18.5/9.2 mm Hg in controls. A first major cardiovascular event
occurred in 242 candesartan patients and in 268 controls. The risk
reduction with candesartan was 10.9%. Candesartan-based treatment reduced
non-fatal stroke by 27.8% and all stroke by 23.6%.
There were no significant differences between the groups in myocardial
infarction and cardiovascular mortality. Mini Mental State Examination
scores fell from a mean of 28.5 to 28.0 with candesartan group and from
28.5 to 27.9 in controls.
Similar proportions of patients in the two treatment groups had
significant cognitive decline or developed dementia.
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© 2002 Global Action on Aging
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