IMPACT OF SEX AND ANTIHYPERTENSIVE MEDICATION ON GLOBAL COGNITION IN PRIMARY CARE OLDER ADULTS

Abstract

Objective: The goal of this study is to determine the impact of sex on the effects of different antihypertensive drugs classes, whether in monotherapy or in combination therapy, on the global cognition scores of older adults to identify the most appropriate medication regime in men and women. Design and method: This study used the ESA - Services study, consisting of a sample of 1811 older adults (>65 years) recruited in primary care practices in Quebec-Canada. Participants were examined for the Mini-Mental State Examination (MMSE), at three-time points: baseline, + 3 years, and + 4 years. Participants granted access to their provincial health record to assess: hypertension status, time since diagnosis, list of medications, and ptimisesations. Antihypertensives consumed by participants were divided into six categories: Diuretics, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and others. We assessed the changes in MMSE scores during the 4-year follow-up on the six antihypertensive groups per sex. Results were adjusted for age, years of education, and the Carlson Comorbidity Index. Results: Women had higher mean MMSE scores than men regardless of their blood pressure status, even though men had more years of formal education (10.65 vs 11.74 years, p < .001). Compared to normotensive individuals, hypertensive women had the highest mean MMSE score at each time point (T1 28.591 (SE .064); T2 28.282 (SE .118); T3 28.524 (SE .119)), while hypertensive men had the worst (T1 28.038 (SE .070); T2 27.694 (SE .125); 27.809 (SE .128)). Women taking angiotensin II receptor antagonists showed the highest MMSE scores (p < .003), and men taking diuretics had the lowest MMSE scores (p < .001) after a 3-year follow-up. Combination therapy of two or three antihypertensives drugs was associated with higher scores in women at T1 and T2 (p < .001). In men, the use of three antihypertensives showed a sharp decrease in MMSE scores from T1 to T3 (p < .001). Conclusions: Sex differences in global cognition outcomes in older adults are related to the type and number of antihypertensive drugs used. Effective antihypertensive treatment should consider the impact of sex to ptimise the effect of pharmacological interventions on cognition.