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      Eprosartan-based hypertension therapy, systolic arterial blood pressure and cognitive function: analysis of Middle East data from the OSCAR study

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          Abstract

          Background:

          Studies have indicated a relationship between hypertension and cognitive function. The possible effect of antihypertensive therapy on cognitive disorders is therefore a matter of interest.

          Materials and methods:

          The Observational Study on Cognitive function And SBP Reduction (OSCAR) was an open-label, multinational trial designed to evaluate the impact of eprosartan-based antihypertensive therapy on cognitive function in patients with essential hypertension. Eprosartan 600 mg/day for 6 months (with provision for additional medication as needed) was initiated in hypertensive subjects aged ≥50 years. A total of 853 patients in an intention-to-treat cohort from seven countries of the Middle East was identified for subgroup analysis.

          Results:

          Arterial blood pressure was reduced significantly ( P < 0.001) during the study: At the end of 6 months of eprosartan-based therapy, the mean (±SD) reduction from baseline was 32.1 ± 14.3/14.6.3 ± 8.6 mmHg ( P < 0.001). Mean pulse pressure was reduced by 18.3 ± 13.1 mmHg ( P < 0.0001 vs baseline). Blood pressure was normalized (systolic <140 mmHg and diastolic <90 mmHg) in 68.2% of patients. The overall mean Mini-Mental State Examination (MMSE) score after 6 months of eprosartan-based therapy was one-point higher than at baseline ( P < 0.001). MMSE score on completion of 6 months’ follow-up was either unchanged or increased from baseline in 793 (93%) individuals and decreased in 60 (7%). Factors associated with stability of or improvement in cognitive function included MMSE score at baseline, diastolic blood pressure (DBP) at baseline, and treatment-induced change in DBP.

          Conclusion:

          Results from the Middle East subgroup of OSCAR are supportive of the hypothesis that antihypertensive therapy based on angiotensin-receptor blocker therapy with eprosartan may be associated with preservation or improvement of cognitive function.

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          Most cited references20

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          Correction of arterial structure and endothelial dysfunction in human essential hypertension by the angiotensin receptor antagonist losartan.

          Structural and functional alterations of the vasculature may contribute to complications of hypertension. Because angiotensin II may be pivotal in some of these vascular abnormalities, we tested the hypothesis that the angiotensin type 1 (AT(1)) receptor antagonist losartan, in contrast to the beta-blocker atenolol, would correct resistance artery abnormalities in patients with essential hypertension. Nineteen untreated patients with mild essential hypertension (47+/-2 years, range 30 to 65 years; 57% male) were randomly assigned in double-blind fashion to losartan or atenolol treatment for 1 year. Nine age/sex-matched normotensive subjects were also studied. Both treatments reduced blood pressure to a comparable degree (losartan, from 149+/-4.1/101+/-1.6 to 128+/-3.6/86+/-2.2 mm Hg, P<0.01; atenolol, from 150+/-4.0/99+/-1.2 to 130+/-3.2/84+/-1.4 mm Hg, P<0.01). Resistance arteries (luminal diameter 150 to 350 microm) dissected from gluteal subcutaneous biopsies were studied on a pressurized myograph. After 1 year of treatment, the ratio of the media width to lumen diameter of arteries from losartan-treated patients was significantly reduced (from 8.4+/-0.4% to 6.7+/-0.3%, P<0.01). Arteries from atenolol-treated patients exhibited no significant change (from 8. 3+/-0.3% to 8.8+/-0.5% after treatment). Endothelium-dependent relaxation (acetylcholine-induced) was normalized by losartan (from 82.1+/-4.9% to 94.7+/-1.1%, P<0.01) but not by atenolol (from 80. 4+/-2.7% to 81.7+/-4.6%). Endothelium-independent relaxation (by sodium nitroprusside) was unchanged after treatment. The AT(1) antagonist losartan corrected the altered structure and endothelial dysfunction of resistance arteries from patients with essential hypertension, whereas the beta-blocker atenolol had no effect.
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            Relationship between arterial stiffness and cognitive function in elderly subjects with complaints of memory loss.

            To evaluate the relationship between arterial stiffness and cognitive function in a population of elderly subjects reporting memory loss. We studied the association between cognitive function and arterial stiffness in 308 consecutive elderly subjects attending a geriatric outpatient clinic reporting memory impairment. Subjects were classified into 4 categories according to neuropsychological evaluation: normal cognitive function, mild cognitive impairment (MCI), Alzheimer disease (AD), or vascular dementia (VaD). Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV) measurement using Complior. In this population, 78+/-8 years of age (women 64%), AD was present in 41%, VaD in 6%, MCI in 27%, and 26% of subjects had normal cognitive function. After adjustment for age, gender, systolic blood pressure, education level, cardiovascular diseases, and antihypertensive therapy, a significant association was observed between PWV and cognitive status (P<0.0001). PWV appears significantly higher in subjects with VaD (15.2+/-3.9 m/s) or AD (13.3+/-2.9 m/s) than in those without cognitive impairment (11.5+/-2.0 m/s; P<0.001). Moreover, PWV was higher in subjects with MCI (12.6+/-2.6 m/s) than in those without cognitive impairment (11.5+/-2.0 m/s; P=0.01). For each 2 m/s increment in PWV, the adjusted odds ratio (95% CI) was 1.73 (1.27 to 2.47) for AD and 3.52 (1.87 to 8.05) for VaD. Our results showed a relationship between arterial stiffness and cognitive impairment, suggesting that functional changes of the arterial system could be involved in the onset of dementia (VaD or AD types).
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              Prevalence of cardiovascular risk factors in the Middle East: a systematic review.

              The aim of this study was to determine the prevalence of key cardiovascular risk factors in the Middle East region. We conducted a systematic review of the literature through searches in the MEDLINE/PubMed and PARLINE databases between January 1980 and April 2005. Cohort studies published from 1980, in English, which included at least 1000 participants that reported the prevalence of at least one of the following; diabetes mellitus, obesity (body mass index > or =30 kg/m(2)), hypertension, hyperlipidemia, and smoking in the Middle East region. Data were abstracted using standardized data abstraction forms. Studies were combined using random-effect models. In total, 51 studies (267 537 participants) were included. On the basis of a random-effect model, the overall prevalence of obesity was 24.5% [95% confidence interval (CI): 21.8-27.5; I(2): 99.3%; 24 studies], diabetes mellitus was 10.5% (95% CI: 8.6-12.7%; I(2): 99.4%; 24 studies), hypertension was 21.7% (95% CI: 18.7-24.9; I(2): 99.5%; 24 studies), smoking was 15.6% (95% CI: 12.3-19.6%; I(2): 99.7%; 21 studies). Smoking was more common in men than women, whereas obesity and hypertension were more common in women. The overall prevalence was not calculated because of marked variations in the definition of dyslipidemia among studies. There is a high prevalence of diabetes mellitus, obesity, hypertension, and smoking in the Middle East. The prevalence of obesity and hypertension was higher in women, whereas prevalence of smoking was higher in men. These data suggest that cardiovascular disease will be a major health problem in the Middle East.
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                Author and article information

                Journal
                Vasc Health Risk Manag
                Vascular Health and Risk Management
                Vascular Health and Risk Management
                Dove Medical Press
                1176-6344
                1178-2048
                2011
                2011
                01 August 2011
                : 7
                : 491-495
                Affiliations
                [1 ]Rashid Hospital of Dubai, Dubai, United Arab Emirates;
                [2 ]Abbott Gulf – Levant;
                [3 ]Division of Cardiology, American University of Beirut, Beirut, Lebanon;
                [4 ]Abbott Products Operations AG, Allschwill, Switzerland;
                [5 ]EvidenceBased Communication (EBC), Rueil-Malmaison, France;
                [6 ]Fovéa Group, Rueil-Malmaison, France;
                [7 ]Departments of Clinical Pharmacology and Cardiology, Institut National de la Santé et de la Recherche Médicale U1048, Université de Toulouse-UPS, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
                Author notes
                Correspondence: Ghazi Ahmad Radaideh, Rashid Hospital of Dubai, PO Box 4545, Dubai, United Arab Emirates, Tel +97143374000, Fax +97143368152, Email garadaideh@ 123456dohms.gov.ae
                Article
                vhrm-7-491
                10.2147/VHRM.S19699
                3166187
                21915165
                2d4fe1b8-23cd-41e6-bf07-5b27cdf5c839
                © 2011 Radaideh et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                : 1 August 2011
                Categories
                Original Research

                Cardiovascular Medicine
                hypertension,eprosartan,cognitive function,middle east
                Cardiovascular Medicine
                hypertension, eprosartan, cognitive function, middle east

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