TL;DR: A 7-year randomized clinical trial found that combining telmisartan (blood pressure medication) and rosuvastatin (cholesterol medication) significantly reduced dementia risk and cognitive decline in elderly hypertensive patients. The combination was particularly effective for patients carrying the APOE ε4 gene variant, which is associated with increased dementia risk.
Key Findings:
- Trial Overview
- Participants: 1,244 hypertensive patients aged ≥60 years
- Duration: Average 7 years (2008-2017)
- Design: Double-blind, randomized, placebo-controlled, 2×2 factorial
- Location: Six cities in Shandong, China
- Primary Results
- Dementia incidence: 176 patients (2.0% per year)
- Both medications independently reduced dementia risk
- Synergistic effect: Combination therapy more effective than either drug alone
- APOE ε4 carriers (26% of participants) showed:
- Higher baseline risk of cognitive decline
- Stronger response to rosuvastatin treatment
- Statistical Significance
- Combination therapy vs. control: P<0.001 for all cognitive measures
- Drug interaction: Significant synergistic effect (Padjusted<0.001)
- APOE ε4 × rosuvastatin interaction: Significant (Padjusted=0.022)
- Methodology Strengths
- Multiple cognitive assessment tools used
- Adjustment for confounders including:
- Blood pressure changes
- Lipid levels
- Stroke incidence
- Education level
- Basic medication (hydrochlorothiazide)
- Key Limitations
- Single ethnicity study
- No subclassification of dementia types
- Socioeconomic status not controlled
- Gender differences not analyzed
- All patients received hydrochlorothiazide as basic medication
This study provides strong evidence for considering combination therapy with telmisartan and rosuvastatin in elderly hypertensive patients, particularly those carrying the APOE ε4 allele, for dementia prevention.
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