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No Effect on BP Cognition, Lipid Reduction: HOPE-3 Released



Cognition is the result of HOPE-3 trial, and is investigating blood pressure and cholesterol levels in individuals, but without the need for cardiovascular disease or treatment, but have been published in moderate cardiovascular risk.

When the results were presented at the American Heart Association Scientific Sessions in 2016, they did not study the cognitive degradation treatment strategy, the results of a study exploration lead to the diminution of the cognitive decline of cognitive risk.

Cognition results were published online yesterday Neurology.

"At first glance, our results do not seem to reduce the arterial pressure of cognitive function. However, when we analyze deeper post hoc studies, it appears to benefit the treatment of those who are at greater risk." Bosch, PhD, McMaster University, Hamilton, Canada, commented Medscape Medical News.

He underlines that this is in line with SPRINT MIND, which demonstrates the slowdown in the cognitive attack of lower blood pressure groups.

"SPRINT trial was much more at risk for the population, with all the patients with high blood pressure, and the treatment was focused on different objectives," said Bosche. "HOPE-3 had a moderate cardiovascular risk, but most participants did not have blood pressure."

Their goal was to benefit from the overall strategy of low blood pressure blood pressure reducing knowledge, although the participants did not base their hypertension, he said.

"The theory behind this is that we are convinced that, when we believe that blood pressure is very stroke and a TIA, we believe that the reduction of stress in the vascular dysfunction of the dysfunction in the brain can reduce the perfusion in the brain and reduce the accent fingerprint and thus a cognitive decline. It was a disappointment, "Bosche said.

However, they have seen that the highest risk groups of patients have had an elevated blood pressure. "This suggests that the negative effects of blood pressure on moderate cardiovascular risk in individuals suggest that they have a high blood pressure threshold."

When analyzing curiosity, only 70-year-old individuals included, Bosche said: "Our results suggest since the 70's [years old] With normal blood pressure, you will probably not be the main problem for vials, for example, stroke and cognitive decline increase hypertension. [the] in the future ".

Lipid Neutral Results – Good News?

About the overall loss of lipids, Bosche said: "Cholesterol does not have a strong stroke with blood pressure, maybe to reduce the reduction of cholesterol decreased cognitive. I wanted to see a benefit in cognitive decline with statistic, because we do not see any difference yet a positive result da "picture.

"There have been worries that have been detrimental to the impact on statin imbalances and in anecdotal reports, and the FDA has warned about prescription information," explains Bosch. "However, our results do not show individuals an additional cognitive awareness, taking a stance of placebo, to scare them afraid."

Bosche emphasized that today's results do not prevent healthy diets and regular exercises that prevent any previous observations from preventing cognitive decline. "These benefits can be mediated through different mechanisms, not just lipids or blood pressure restrictions. Improved living quality improvement packages are definitely sound adaptation," he said.

The main HOPE-3 trial had 12,105 participants (over 55 men and women over 65, at least at least one additional clinical cardiovascular risk, or women over 60 years of age, with additional risk factors).

They were designed with 2 × 2, lowering candesartan plus hydrochlorothiazide (HCTZ) with high blood pressure, using rosuvastatin as well as cholesterol, either in combination with placebo.

The main results are followed by an average follow-up of 5.6 years: there is no consequence of blood pressure, reducing the treatment of vascular events, but reducing the 24% reduction in BP levels. Rosuvastatin has reduced vascular diseases to 25% in all participants.

Based on the subconcentric study conducted under the age of 70 under the current publication, the cognitive analysis at the beginning and end of the study (16.26 years) was studied (mean age 5.7).

In this population, candesartan / HCTZ reduced blood pressure of 6.0 mm Hg and rosuvastatin LDL reduced cholesterol 24.8 mg / dL.

Results were not shown for the first time – Digit Symbol Substitution Test (DSST) change in score. In general, DSST had a negative downturn of 5.4 points from the beginning. The average difference in DSST score scores -0.91 (95% confidence interval) [CI], -2.25 and 0.42) compared with Candesartan / HCTZ, compared with placebos, -0.54 (-1.88-0.80), compared to rosuvastatin, and -1.43 (-3.37 to 0.50) in combination therapy.

Two more meaningful discussions were found: 12 Items in Montreal Nursing (mMoCA), and Trail Making Test Part B (TMT-B).

The study exploration subgrogram of 181 participants with blood pressure and lipid lowering medication compared to double bowel syndrome with basic blood pressure (average 156 mm Hg) and high-temperature LDL-C (164 mg / dL average), DSST- A significant reduction in the cognitive decline that is measured (from 5.84 points to 10.30 points reduction, P interaction = .04).

"Our results indicate the effect of the combination of blood pressure and lipids decreased, according to the prevention of cognitive decline in high pressure blood pressure, can benefit those who have the highest cardiovascular risk," the authors conclude. "This is in line with the results of the studies, with the highest baseline systolic pressure".

Bosche said that he was expecting blood pressure to reduce strength behind that pressure, "but the numbers are very small, so it is almost impossible to get specific conclusions."

Taking into account the limitations of the study, researchers have been taking the medication for over 6 years to prevent cognitive prevention. Likewise, the participants enrolled in the trial, especially if they were better than the population and had a lesser risk of cognitive impairment.

The partners published by Christopher Chen, MD, National University Health System, Singapore, and Craig Anderson, MD, The George Institute for Global Health, Sydney, Australia suggest that preventive treatment should begin as soon as possible, with no effect on cognitive decline.

For 70 years and over, "it is arguable that it is too late to reverse physiopathological processes such as cardiovascular risks such as hypertension and hyperlipidemia."

The effect of the treatment is also demonstrated that the most sensitive probability tests could be detected, or if they are used by neuroimaging, to identify important diseases of the brain's small bowel and those that are silent in advance. cognitive impairment risk

Editorials require more research on mechanisms, treatment purposes and biomarkers to identify high risk people in cognitive decline. "The statistical overview of different variables, different approaches to treatment, longer monitoring and confrontation exceeds the randomized controlled trials", the authors suggest.

"Even years delaying the birth of an anniversary, they would be able to improve public health health," they concluded.

The study was financed by the Canadian Health Research Institutes and AstraZenece. Bosche has no financial relationship. Chen has been serving scientists fi c consultative committees and Lundbeck and Accera consultants; He has received a travel financing from Moleac, Eisai and Lundbeck; TauRx, Eisai, Nutricia and Lundbeck's research support. Anderson was served by scientists fi The Amgen Consultation Committee has received Takeda's gift, honor and travel funding.

Neurology. Published online, February 27, 2019. Summary, Editorial

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