Effect of Antihypertensive Agents on Cognitive Functioning

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As stated in Chapter i, it has been well documented that essential hypertension is associated with subtle cognitive impairments that can often be detected only by means of specific neuropsychological assessment strategies (see Waldstein et al., 1991). If hypertensive patients are generally aware of these cognitive deficits, they may need to exert more effort or become more engaged with mental tasks in order to perform at an acceptable level. Their exaggerated cardiovascular response to mental stress may reflect their increased effort or engagement. If pharmacologic interventions result in improved cognitive ability, as initially hypothesized by Miller et al. (1984), the mechanism of action for antihypertensive medications may involve cognitive functioning. As such, one would expect antihypertensive agents to 'normalize' the cognitive deficits commonly observed in hypertensive patients with ongoing treatment. Let's examine the body of evidence examining the effect of antihypertensive agents on various measures of cognitive functioning.

Muldoon et al. (1991) conducted a review of over 50 studies that have examined the effect of antihypertensive pharmacologic agents on various measures of cognitive performance. Although their review of the literature uncovered some studies finding improvement in cognitive functioning with antihypertensive therapy, the vast majority of studies have found that treatment with most types of antihypertensive agent had very little effect on measures of cognitive activity. There was some evidence, however, linking administration of adrenergic inhibiting agents (beta-blockers or central-acting alpha-agonists) to poorer performance on speeded psychomotor tasks. Conversely, improvements on psychomotor tasks were noted in conjunction with use of ACE inhibitors, although only in a few studies.

Although diminished performance on tasks involving psycho-motor speed has been associated with numerous antihypertensive agents, more recent research has found improved performance on working memory tasks with these same pharmaceutical agents (Mul-doon et al., 2002), particularly ACE inhibitors or calcium channel blockers (Amenta et al., 2002). Therefore, the newer classes of antihy-pertensive drugs appear to exhibit a more positive outcome with respect to specific cognitive functions than the older classes of drugs.

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