Effects of valsartan compared with enalapril on blood pressure and cognitive function in elderly patients with essential hypertension

Objective: This prospective, randomised, open-label, blinded-endpoint study was to compare the effects of the angiotensin II (Ang II) AT1 receptor antagonist valsartan with those of the ACE inhibitor enalapril on blood pressure (BP) and cognitive functions in elderly hypertensive patients. Methods: One hundred and forty-four patients aged 61-80 years with mild to moderate essential hypertension (DBF ≥95 mmHg and <110 mmHg at the end of a 2-week placebo run-in period) were randomly assigned to once daily (o.d.) treatment with valsartan 160 mg (n = 73) or enalapril 20 mg (n = 71) for 16 weeks. The patients were examined every 4 weeks during the study, with pre-dose BP (standard mercury sphygmomanometer, Korotkoff I and V) and heart rate (pulse palpation) being recorded at each visit. Cognitive function was evaluated at the end of the wash-out period and after 16 weeks of active treatment by means of five tests (verbal fluency, the Boston naming test, word list memory, word list recall and word list recognition). Results: Both valsartan and enalapril had a clear antihypertensive effect, but the former led to a slightly greater reduction in SBP/DBP at 16 weeks (18.6 ± 4.6/ 13.7 ± 4.0 mmHg vs 15.6 ± 5.1/10.9 ± 3.9 mmHg; P<0.01). Enalapril did not induce any significant changes in any of the cognitive function test scores; valsartan significantly increased the word list memory score (+11.8%; P <0.05 vs baseline and P <0.01 vs enalapril) and the word list recall score (+18.7%; P <0.05 vs baseline and P <0.01 vs enalapril), but not those of the other tests. Conclusion: These findings indicate that, in elderly hypertensive patients, 16 weeks of treatment with valsartan 160 mg o.d. is more effective than enalapril 20 mg o.d. in reducing BP, and (unlike enalapril) improves some of the components of cognitive function, particularly episodic memory.