Abstract Body: Background: Elderly hypertensive patients with cognitive impairment not only exhibit reduced processing speed and executive function but also suffer significant deficits in memory and motor speed, adversely affecting their quality of life. This study employs a network meta-analysis to evaluate the effects of different antihypertensive regimens on cognitive function and blood pressure changes in elderly hypertensive patients.
Methods: A comprehensive search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang and VIP databases for randomized controlled trials on different antihypertensive regimens for elderly hypertensive patients. Data analysis and graphing were performed using Review Manager 5.3 and Stata 16.0 software.
Results: A total of 16 studies involving 11,694 elderly hypertensive patients and six antihypertensive regimens were included. The network meta-analysis results indicated that elderly hypertensive patients treated with angiotensin II receptor blockers (ARBs) had a greater change in cognitive function scores compared to those receiving usual care (standardized mean difference [SMD] = 0.46, 95% CI [0.23, 0.70]), angiotensin-converting enzyme inhibitors (ACEIs) (SMD = 0.33, 95% CI [0.06, 0.61]), beta-blockers (BBs) (SMD = 0.48, 95% CI [0.17, 0.78]), and diuretics (SMD = 0.32, 95% CI [0.01, 0.63]). Similarly, patients treated with calcium channel blockers (CCBs) showed greater changes in cognitive function scores compared to those receiving usual care (SMD = 0.37, 95% CI [0.04, 0.70]) and BBs (SMD = 0.38, 95% CI [0.02, 0.74]). The SUCRA rankings for changes in cognitive function scores among different antihypertensive regimens were ARB (93.6%), CCB (81.2%), diuretics (47.1%), ACEI (43.4%), usual care (17.9%), and BB (16.8%).
Conclusion: The current evidence suggests that, compared to usual care, ACEIs, BBs, CCBs, and diuretics, ARBs might be the optimal regimen for improving cognitive function in elderly hypertensive patients.