Antihypertensive

treatment was sometimes found to be protective in observational studies. In a community cohort study of 1810 persons aged 75 years or older, the prevalence of dementia was significantly lower among patients being treated for hypertension than among those not taking antihypertensive medications (P<0.001).34 In The Inhibitors,research,lifescience,medical Honolulu-Asia Aging Study, early and aggressive blood pressure control lessened the likelihood of cognitive impairment in later life.19 Similarly, in the EVA study, hypertensive subjects receiving adequate treatment had no increased risk of cognitive decline compared with normotensive subjects.20 Randomized trials of blood pressure-lowering drugs on the risk of dementia Prevention of dementia in stroke patients: the PROGRESS study Blood pressure-lowering therapy with the long-acting ACE inhibitor

perindopril combined with the diuretic indapamide reduces the risk of poststroke dementia by one third and the risk of severe cognitive decline by nearly one half, according to the results from the PROGRESS study (Perindopril Inhibitors,research,lifescience,medical pROtection aGainst REcurrent Stroke Study).35 PROGRESS was a randomized, double-blind, placebo-controlled trial that enrolled 6105 men and women, with a mean age of 64 years, with prior stroke or transient ischemic attack (TIA), from 172 institutions in 10 countries in Asia, Australia, and Europe. Participants were randomized Inhibitors,research,lifescience,medical to active treatment (n=3051) or placebo (n=3054).36,37 Active treatment was comprised of perindopril 4 mg daily Inhibitors,research,lifescience,medical for all participants, along with 2.5 mg daily of the diuretic indapamide (2 mg in Japan) in patients in whom a diuretic was neither specifically indicated nor contraindicated. The main results of see more PROGRESS38 were that active treatment with perindopril Inhibitors,research,lifescience,medical alone or with indapamide reduced blood pressure by 9/4 mm Hg over 4 years of follow-up, and was associated with an overall reduction of 28% in the risk of recurrent strokes (the primary outcome of the study) compared with placebo (P<.0001 among hypertensive and nonhypertensive patients with a history of stroke or TIA). only Active

treatment also reduced the risk of total major vascular events by 26%. Combination therapy with perindopril plus indapamide reduced blood pressure by 12/5 mm Hg and stroke risk by 43%. One of the secondary outcomes of PROGRESS was dementia and severe cognitive decline. During the follow-up period of 4 years, dementia (diagnosed according to DSMIV criteria) and severe cognitive decline (a drop of ≥3 points in the Mini Mental State Examination [MMSE]) were assessed. Median MMSE score at baseline was 29 (range, 27 to 30); a large proportion of patients (41%) had good cognitive function (MMSE =30), but 16% had cognitive impairment (MMSE <26). Over 25% of patients screened positive for dementia (768 and 812 in the active treatment and placebo groups, respectively).