Reducing blood pressure may prevent dementia. (Scope Trial Data).

BERLIN -- Prevention of dementia may emerge as a new indication for antihy-pertensive therapy in the near future, Dr. Lennart Hansson predicted at the 24th Congress of the European Society of Cardiology.

And there's another related emerging indication: prevention of further cognitive decline in patients with mild cognitive dysfunction, added Dr. Hansson, professor of clinical hypertension research at the University of Uppsala, Sweden.

Dr. Hansson, who presented this year's annual Denolin Lecture on clinical cardiology cited intriguing new evidence in support of these predictions. For example, in the soon-to-be-published Study on Cognition and Prognosis in the Elderly (SCOPE), hypertensive subjects with normal to slightly compromised cognitive function at baseline demonstrated significantly better preservation of cognitive function with candesartan than with diuretic-based blood pressure lowering over a 3- to 5-year follow-up.

Dr. Hansson served as cochair of SCOPE, a 15-nation study in which 4,937 mildly hypertensive patients aged 70-89 were randomized to the angiotensin-receptor blocker candesartan or diuretic-based therapy. Serial Mini-Mental Status Exams (MMSEs) conducted during more than 18,000 patient-years of follow-up showed that among patients with a baseline MMSE of 24-28--indicative of normal to slightly impaired cognitive function--those in the candesartan arm had a mean 0.5-point decline in MMSE scores during follow-up, compared with a 6-point drop in those on a diuretic. The cognitive benefit was even more pronounced in patients over age 85.

A SCOPE substudy involving 250 participants in the United Kingdom who underwent more sophisticated neuropsychological testing confirmed the MMSE data.

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