Influence of angiotensin-converting enzyme inhibition of psychometric tests in elderly hypertensives

Forty elderly patients with moderate essential hypertension were treated with enalapril at an initial dose of 10 mg/day. After two weeks the dosage was increased to 20 mg/day if supine diastolic pressure remained higher than 100 mmHg. The study duration was four months. A full blood chemistry investigation (including serum urea, potassium, sodium, creatinine, and uric acid, transaminase activity, cholesterol, glucose, triglycerides, red and white blood cell count, platelet count, urinary potassium and sodium and urine analysis) was performed at the beginning and after 1,2,3 and 4 months of the study. The electrocardiogram was controlled at baseline and at the end of the study. Psychological behavior and cognitive functions were assessed in baseline conditions and after three months of enalapril therapy by three different psychometric tests: Mini-Mental State, Plutchik test, and scale for clinical assessment in geriatrics (SCAG). Enalapril (10 mg/day) was able to normalize blood pressure levels in 36 patients, while in four patients it was ineffective, even at a dose of 20 mg/day. No variation was found in the other parameters, except in the psychometric tests. In the responder group (36 patients) we observed a positive variation in the Mini-Mental State (P < 0.05), Plutchik test (P < 0.05), and SCAG (P < 0.001). In the nonresponder group the psychometric tests scores remained unvaried in three patients, while in one patient the score became worse. This patient did not correctly follow therapy, often refusing antihypertensive treatment or pretending to swallow medication. This behavior was due to the preexistence of marked clinical signs of depression, causing a lack of confidence in medical intervention. No other side effects were observed. In conclusion, our data show that enalapril is able to reduce blood pressure and to protect or improve cognitive functions in elderly hypertensive patients.