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Comment & Response
March 2016

Discontinuation of Antihypertensive Treatment in Elderly Patients and Cognitive Function—Reply

Author Affiliations
  • 1Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
  • 2Department of Psychiatry, CAPRI-University of Antwerp, Antwerp, Belgium
JAMA Intern Med. 2016;176(3):409-410. doi:10.1001/jamainternmed.2015.8345

In Reply We thank Imprialos et al for their comments and interest regarding the results of the DANTE study Leiden1 published in a recent issue of JAMA Internal Medicine. Imprialos et al asked for 2 important additional analyses regarding the effect of pulse pressure (PP) and estimated glomerular filtration rate on cognitive function.

A previous publication showed that in institutionalized patients older than 80 years a higher PP, as an indicator of arterial stiffness, predicted cognitive decline a year later.2 In the DANTE study Leiden, there were 356 participants with the mean (SD) age of 81.3 (4.4) years,1 and additional cross-sectional analyses at baseline showed that tertiles of PP (low tertile, <59 mm Hg; middle tertile, 59-72 mm Hg; and high tertile, >72 mm Hg) were not associated with overall cognition compound scores (mean [standard error], -0.02 [0.09]; 0.04 [0.09]; and -0.02 [0.10], respectively; P = .63), after adjustment for sociodemographics and a history of cardiovascular disease. Similarly, in longitudinal analyses that were additionally adjusted for randomization group, tertiles of baseline PP were not associated with the change in overall cognition compound scores (mean [standard error], -0.003 [0.10]; -0.06 [0.09]; and 0.05 [0.10], respectively; P = .29).

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