Effects And Post-effects Of Anti-hypertension Treatment In Very Elderly Hypertensives

Background:With the development of society and health services, the elderly aged80and overhas being one of the fastest growing groups. The incidence, morbidity, and mortalityof hypertension in the group were higher than any other age group, but they weretreated and studied scarcely. Therefore they must to be concerned. Because of the highmortality rate, the group was not included in most previous clinical trials. So securityand effectiveness of anti-hypertensive treatment could not be evaluated accurately.The result of Hypertension in the Very Elderly Trial (HYVET) confirmed that therisks of death, stroke, fatal stroke, heart failure and cardiovascular events werereduced significantly in patients who received antihypertensive therapy. However,whether very elderly hypertensives should be treated as well as the optimalmanagement are still controversial. With the rapid growth of these people, the study ofantihypertensive therapy to them is necessary. In addition, cognitive function andquality of life may be more meaningful parameters for the very elderly hypertensivesin evaluating of the comprehensive benefits of anti-hypertensive therapy.Objective:1. To observe the relationship of cognitive function with blood pressure, bloodpressure rhythm, blood pressure variability, and carotid artery intima-media thickness(IMT) in very elderly hypertensive patients. 2. To investigate the changes of cognitive function and arterial elasticity of postanti-hypertension treatment between treatment group and control group.3. To explore the differences of incidence in stroke and myocardial infarction, totalmortality and cardiovascular mortality between treatment group and control group.4. To evalue the post-effects of anti-hypertensive treatment in very elderlyhypertensive patients.MethodsIn the present study, we recruited300very elderly hypertensive patients80orover years old. All volunteers were randomized into two groups, namely, treatmentgroup (150cases), control group (150cases).Age, height, weight, blood pressure, and end point events were collected in allpatients at the baseline and the follow-up visit. Biochemical parameters (such asfasting plasma glucose, lipids, uric acid, blood uric nitrogen, and serum creatinine),24hour blood presure rhythm, carotid intima-media thickness, carotid-radial pulse wavevelocity, and cognitive function were determined at baseline, annual follow-up visit,and the last follow-up visit.24hour blood presure rhythm were obtained using24hour ambulatory bloodpressure monitoring (24h ABPM). Carotid intima-media thickness (IMT) wasmeasured using GE vivid i ultrasonography. Carotid-radial pulse wave velocity(crPWV) were messured by the Complior device.The patients were divided into dipper type rhythm group or non-dipper typerhythm group according to24h blood pressure rhythm. Deppending on carotidintima-media thickness, the volunteers were categorized into normal IMT group orhigh IMT group. Base on carotid-radial pulse wave velocity (crPWV), the cases wereclassficated into low crPWV group or high crPWV group. Cognitive function ofpatients were evaluated by Mini-Mental State Examination (MMSE).All patients were followed up for five years. After treatment, opening treatmentwas given to them for two years. We recorded high, weight, blood pressure and complet the relevant questionnaire and collecting endpoint events.Result1. Baseline:①Systolic blood pressure, diastolic blood pressure, body mass index,total cholesterol and carotid intima-media thickness(IMT) in high crPWV group werehigher than those in low crPWV group (P＜0.05).②Systolic blood pressure,diastolic blood pressure, total cholesterol, fasting plasma glucose and carotid-radialpulse wave velocity(crPWV) in normal IMT group were lower than those in high IMTgroup(P＜0.05);③IMT was positively correlated with systolic blood pressure,diastolic blood pressure, fasting plasma glucose and total cholesterol, and negativelycorrelated with high density lipoprotein cholesterol; crPWV was positively correlatedwith systolic blood pressure, diastolic blood pressure, total cholesterol and carotidintima-media thickness(IMT); score of cognitive function was negatively correlatedwith fasting plasma glucose, total cholesterol and carotid intima-mediathickness(IMT);④Multiple liner regression showed that: IMT(mm)=0.214+0.008×DBP(mmHg）+0.085×TC(mmol/L)-0.202×HDL-C(mmol/L), DBP, TCand HDL-C were main risk factors for IMT; crPWV(m/s)=-13.19+18.734IMT(mm)+0.123BMI(kg/m2), IMT, BMI were main risk factors for crPWV; MMSE=18.931+0.673TC(mmol/L), TC was main risk factors for cognitive function;⑤scores of cognitive function in non-dipper type pressure*high IMT group were lowerthan that in dipper type pressure*high IMT group and dipper type pressure*normalIMT group(P＜0.05).2. Two years follow-up visit:①Systolic blood pressure, diastolic blood pressure andserum creatinine in treatment group were lower than those in control group(P＜0.05)but the high density lipoprotein was higher than that in control group(P＜0.05);②Compared with control group, the rate of normal IMT patients was higher(P＜0.05)and compared with the baseline, the rate of normal IMT patients was higher too(P＜0.05) after2years; compared with control group, the rate of low crPWV patients washigher(P＜0.05) and compared with the baseline, the rate of low crPWV patients was higher too(P＜0.05) after2years.3. Five years follow-up visit:①scores of cognitive function in treatment group werehigher that in control group(P＜0.05); compared with before treatment, scores ofcognitive function in both groups declined(P＜0.05).②compared with control group,the IMT was lower and the rate of normal IMT patients was higher(P＜0.05);compared with the baseline, the rate of normal IMT patients was higher (P＜0.05) inthe treatment group; compared with control group, the rate of low crPWV patientswas higher(P＜0.05).③after treatment, incidences of stroke and myocardialinfarction in treatment group was lower than that in control group(P＜0.05).④aftertreatment, cardiovascular mortality in treatment group was lower than that in controlgroup(P＜0.05).4. Opening treatment:①There was no difference in the rate of normal IMT patientsbetween the rate of low crPWV patients(P＞0.05).②The decline rate of MMSE，orientation, memory capability, attention and calculation in the drug treatment groupwere significantly lower than those in control group (P＜0.01).③Cardiovascularmortality in treatment group was lower than that in control group(P＜0.01).Conclusions1. In very elderly hypertensive patients, cognitive function is negatively correlatedwith fasting plasma glucose, total cholesterol and carotid intima-media thickness(IMT), and there may be duplicate effect between IMT and irregular blood pressurerhythm.2. Anti-hypertensive treatment is beneficial and decreased the damage of cognitionfunction in very elderly hypertensive patients.3. Anti-hypertensive therapy can delay the progression of arterial aging speed in veryelderly hypertensive patients.4. Anti-hypertensive therapy did not reduce all-cause mortality, but can significantlyreduce cardiovascular and cerebrovascular disease mortality in very elderlyhypertensive patients. 5. There were positively post-effects of anti-hypertension. The post effects ofanti-hypertension may be delay the damage of cognition function in very elderlyhypertensive patients, reduce cardiovascular and cerebrovascular disease mortality.