| ObjectiveTo assess the effects of blood pressure lowering treatments for the prevention of cognitive decline on primary hypertension patients with vascular cognitive impairment, and to investigate whether those patients could benefit from the treatment of atorvastatin in addition to blood pressure lowering treatments.Patients and Methods2239 patients with primary hypertension to out-patient clinic or admission were recruited in Lishui city hospital from January 2006 to September 2008. We measured the levels of plasma cholesterol and evaluated the cognitive function of these patients by mini-mental state examination (MMSE). There were 143 patients(100 men and 43 women, mean age 65.31 years and deviation of 4.46 years), with at least six years of education, had MMSE scores lower than 28. Patients with diabetes, thyroid disease, Alzheimer disease, or stroke were excluded.Patients in Group A (n=57), with hypercholesterolemia (the levels of plasma cholesterol higher than 5.18mmol/L), undertook blood pressure lowering treatments and atorvastatin. The others, with normal plasma cholesterol levels, were randomly divided into two subgroups. Patients in Group B1 (n=42), undertook blood pressure lowering treatments and placebo. Patients in Group B2 (n=44), undertook blood pressure lowering treatments and atorvastatin.All of these patients undertook amlodipine 5mg/d at the beginning of the investigation. After 3 weeks of treatment, we doubled the dose of amlodipine to those patients whose blood pressure had not been controlled. After 5 weeks of treatment, we added benazepril 10mg/d to those patients whose blood pressure had not been controlled. After 7 weeks of treatment, we doubled the dose of benazepril to those patients whose blood pressure had not been controlled. Finally, all of these patients had the blood pressure lower than 140/90mmHg.The patients in Group A and Group B2 undertook atorvastatin 20mg/d. Meanwhile, the patients in Group B1 undertook placebo.At baseline and 1 year after treatment, cognitive function was evaluated by using mini-mental state examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), and life quality was evaluated by using the MOS item short from health survey (SF-36).Statistical AnalysisComparisons of baseline scores and the final socres in these three measuring scales of simple Group were performed by the t-test for independent samples and analysis of variance. Comparisons of alteration of scores in these three measuring scales among two Groups were performed by the t-test for compared samples. Statistical Analysis was performed using SPSS version 17.0. A p value<0.05 was considered statistically significant. A p value<0.001 was considered extremely statistically significant. ResultsAfter treatment, the MMSE scores of Group A increased from 26.79±1.26 to 28.91±1.26, and the ADAS-cog scores decreased from 6.96±2.58 to 4.22±2.11, and the SF-36 scores increased from 107.4±2.46 to 113.63±3.34. The MMSE scores of Group B1 increased from 27.36±0.85 to 29.26±0.80, and the ADAS-cog scores decreased from 5.87±1.44 to 3.68±1.54, and the SF-36 scores increased from 108.79±2.61 to 112.99±3.50. The MMSE scores of Group B2 increased from 27.34±0.81 to 29.02±1.05, and the ADAS-cog scores decreased from 5.88±1.62 to 3.60±1.34, and the SF-36 scores increased from 108.45±2.11 to 113.84±3.11. All patients had extremely significant difference between the baseline scores and the final socres in these three measuring scales (P<0.001). After the treatment, there were no significant difference in the alteration of the MMSE scores and the ADAS-cog scores between Group B1 and Group B2. Meanwhile, the increase of the SF-36 scores in Group B2 was more significant than which of Group B1. The increase of the MMSE scores and the SF-36 scores in Group A were more significant than those of Group B2.And the decreases of the ADAS-cog scores in Group A was more significant than those of Group B2.ConclusionBlood pressure lowering treatments can improve cognitive function and life quality in primary hypertension patients with vascular cognitive impairment. The treatment of atorvastatin in addition to blood pressure lowering treatments can improve cognitive function and life quality in primary hypertension patients with vascular cognitive impairment, regardless of the plasma cholesterol levels. Primary hypertension patients with normal plasma cholesterol levels can not have more benefit to cognitive function from the the treatment of atorvastatin in addition to blood pressure lowering treatments, in spite of improving of the life quality. However, primary hypertension patients with hypercholesterolemia can have more benefit to cognitive function from the the treatment of atorvastatin in addition to blood pressure lowering treatments.
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