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The Heart Outcomes Prevention Evaluation-3 (HOPE-3) study looked at the effect of reducing blood pressure (BP) and cholesterol on major cardiovascular (CV) events in patients at intermediate CV risk (but without CV disease at baseline). The results were recently analyzed to see if drug therapy to reduce BP and cholesterol could slow cognitive decline in the older patients in the study (= 70 years). About 1600 patients completed the study and they were divided among four groups: • rosuvastatin (10 mg) to reduce cholesterol PLUS candesartan/hydrochlorothiazide (16 mg/12.5 mg) to reduce BP;
• rosuvastatin plus placebo;
• candesartan/hydrochlorothiazide (16 mg/12.5 mg) plus placebo;
• double placebo

Cognition was tested (with 3 different measures) at baseline and again after about 5.7 years. Cognitive scores declined overall, but there was not a significant difference across the 4 groups. The subgroup with the highest baseline BP (average systolic BP of 156 mmHg) and LDLcholesterol (average 165 mg/dL) did have significantly slower cognitive decline with the combination therapy compared with double placebo.

The authors note that longer BP lowering therapy may be needed to show a cognitive benefit. In patients with high BP and LDL-cholesterol, combination therapy may slow cognitive decline.

• Bosch J, et al. Neurology 2019;92:e1435-e1446.

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