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.