Stress-induced blood pressure elevation in subjects with mild cognitive impairment: Effects of the dual-type calcium channel blocker, cilnidipine

Aim:  We investigated whether mental stress-induced blood pressure elevation was related to cognitive function in the elderly, and further examined the effects of the dual-type calcium channel blocker, cilnidipine, on stress induced hypertension in subjects with mild cognitive impairment.

Methods:  In study I, 39 consecutive outpatients (mean age ± standard deviation, 77 ± 8 years), who were referred to our memory clinic and were not taking any medications, were studied. They were divided into three groups according to cognitive function on the Hasegawa Dementia Scale-Revised (HDSR): group 1 (n = 8), 28 points or more; group 2 (n = 18), 21–27 points; and group 3 (n = 13), 20 points or less. In study II, 14 outpatients with hypertension and mild cognitive impairment (aged 79 ± 8 years; HDSR score, 24 ± 4) were assigned to receive cilnidipine (10–20 mg/day). The control group (n = 10) matched for age, HDSR and blood pressure was followed without cilnidipine.

Results:  In study I, although age and basal blood pressure were similar among the three groups, the blood pressure response to a mental arithmetic test was twice as large in group 2 (26 ± 12 mmHg in systolic pressure and 11 ± 8 mmHg in diastolic pressure) as those in groups 1 and 3. In study II, after 4 weeks, cilnidipine treatment significantly decreased the blood pressure responses to the mental arithmetic test compared to the baseline as well as to those of the control group.

Conclusions:  Stress-induced blood pressure elevations are exaggerated in subjects with mild cognitive impairment. Cilnidipine may have inhibitory effects on stress-induced hypertension.