2. Effects on Psychomotor function tests:
Both the study groups showed Significant (p < 0.01) improvement in the in six letter cancellation test (SLCT) and card sorting test (CST) scores after 3 months compared to baseline. The mean percentage increase of SLCT score was 5.63 % in Telmisartan group and 8.41% in Cilnidipine group. The mean percentage decrease of CST score was 6.73 % in Telmisartan group and 5.57 % in Cilnidipine group. A significant (P < 0.01) improvement in SLCT and no improvement in CST was observed in Cilnidipine group when compared to Telmisartan group (Table - 3).              There was no significant improvement in both the study groups in DLST at the end of the study. But a significant (P < 0.05) improvement was observed in Cilnidipine group at the end of the study compared to Telmisartan group (Table - 3). Secondary Outcomes:
Both the study drugs decreased the systolic and diastolic BP significantly (P < 0.01). The mean percentage decrease in systolic BP was 9.96 % and in diastolic BP was 6.49 %
in Telmisartan group and 10.6 % and 5.21% respectively in Cilnidipine group (Table - 4) (Figure - 3). The decrease in BP was not significant when compared between groups.
Both the study drugs decreased the body weight significantly at the end of the study. The mean percentage decrease of body weight was 1.44 % in Telmisartan group and 1.27% in Cilnidipine group. No significant decrease in Body weight was found when compared between the groups.              There were no serious adverse events reported in any of the study participants. In Telmisartan group one patient had complaint of nausea, one patient complained of light headedness. In Cilnidipine group one patient had complaint of ankle swelling and one patient had complaint of headache. No one stopped treatment because of side effects.Discussion             This study evaluated the effect of two antihypertensive drugs - Cilnidipine and Telmisartan on memory and psychomotor function test on patients, newly diagnosed with stage I hypertension. The memory function of participants was analysed by using PGI memory test [28] which contain 10 different items. This is a standardized and validated test applicable for Indian population. The battery of tests contains test for memory, recall, mental balance, attention and concentration verbal retention, visual retention and visual recognition of objects. The psychomotor function tests used were three simple tests by using pencil and paper. The tests were six letter cancellation test, digit letter substitution test and card sorting test. These tests were developed and validated at our department.               In our study, we did not get significant improvement in remote and recent memory scores compared between Telmisartan and Cilnidipine. But there was a significant increase in remote and recent memory scores in the Telmisartan group compared to baseline. Our results were consistent with the previous studies [20,30,31]. Kavitha et al [20] compared Telmisartan with Olmesartan in 101 hypertensive patients. They also could not find significant improvement in remote and recent memory scores between the groups. Fogari et al [30] compared Losartan with Atenolol in 120 hypertensive patients on memory function. The duration in this study was 6 months. They concluded that losartan group had a significant improvement in both recent and remote memory tests at the end of the study and Losartan showed significant improvement in both memory tests compared to Atenolol.  Another study [31] proved that Telmisartan was associated with an improvement in cognitive functions compared to Lisinopril in metabolic syndrome patients after 12 weeks. A meta-analysis [32] showed that ARBs can enhance cognitive functions in the elderly, especially episodic memory. Though ACE-Is, diuretics, BBs and CCBs did not seem to boost cognitive function in the elderly but were similarly effective to reduce blood pressure as ARBs. This indicated that AT 1 receptor blockers are better than other antihypertensive drugs in enhancing memory and cognition in these patients.             There was a significant increase in attention and concentration scores in both the study groups compared to baseline. But no significant improvement was found when compared between the groups. Our results are in correlation with the results of previous studies [20,21].              We did not get significant improvement in mental balance score comparing between Telmisartan and Cilnidipine. Our results were not consistent with the previous study done by Kavitha et al [20]. In this study more number of subjects were above 60 years and sample size was 104 and duration of treatment was 16 weeks. In our study mean age was 44 years and sample size was 60 only and duration of treatment was 12 weeks.              Cilnidipine significantly improved Visual retention score compared to Telmisartan at the end of study. Our results were not consistent with the previous study [20]. In our study, we found that there was no change in cognitive functions as indicated by delayed recall test, immediate recall test, mental balance test, verbal retention of similar pairs, verbal retention of dissimilar pairs and Visual Recognition scores. We observed an improving trend in these scores more in Telmisartan group, though they were not statistically significant. Our results are consistent with the previous studies [20,30,31].             A significant improvement was observed in Cilnidipine group when compared to Telmisartan group in six letter cancellation test and Digit Letter Substitution Test. Our results were on accordance with previous studies [20,30].                In the present study, it was observed that hypertension was controlled within 3 months of antihypertensive treatment and no worsening of cognitive functions was observed. Our results were consistent with the previous studies [20,33]. There is decrease in the body weight of patients in both the groups at the end of the study.             In conclusion, both Telmisartan and Cilnidipine showed no significant change in cognition, but improving trends in these scores and significant improvement in psychomotor functions in patients with newly diagnosed Stage - I essential hypertension. But Telmisartan showed more improving trends in cognitive and psychomotor functions compared to Cilnidipine.Acknowledgements: we thank our faculty in the Dept. of Medicine and our patients, without whom we are unable to complete this study.Conflict of Interest: The authors have no conflicts of interest to declare.Funding: Self-funding.Data availability statement: The data that support the findings of this study are openly available in a public repository that issues datasets with DOIs. reference numbers are given below.