Telmisartan and Rosuvastatin Synergistically Ameliorate Dementia and Cognitive Impairment in Older Hypertensive Patients With Apolipoprotein E Genotype.

Objective: To investigate the effect of telmisartan, rosuvastatin, or their combination on dementia and to understand the impact of apolipoprotein E(APOE) genotype on the effect of the medications in older patients with hypertension. Methods: This is a double-blind, randomized, and placebo-controlled trial using a 2 x 2 factorial design. Between April 2008 and November 2010, 1,244 hypertensive patients aged >= 60 years without cognitive impairment were recruited from communities in six cities in Shandong area, China. Patients were randomized into telmisartan and rosuvastatin administration after a 2-week washout period.APOEgenotype was identified at the baseline. Possible dementia was determined using the combination of the global cognitive function and Assessment of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: Over an average follow-up of 7 [interquartile range (IQR): 6.7-7.2] years, telmisartan and rosuvastatin significantly reduced the cognitive impairment progression and the incidence of dementia. There was a synergistic interaction between telmisartan and rosuvastatin to reduce the cognitive impairment and the incidence of dementia (P-adjusted< 0.001). The cognitive impairment progression and the risk of dementia were higher in the hypertensive patients with APOE epsilon 4 allele than in those without APOE epsilon 4 allele. Rosuvastatin medication significantly alleviated the cognitive impairment progression and the risks of dementia in patients withAPOE epsilon 4 allele. Conclusion: The combination of telmisartan and rosuvastatin might be aClinical Trial Registration: www.ClinicalTrials.gov, ChiCTR.org.cn, identifier ChiCTRIOR-17013557. Registered on April 12, 2017-Retrospectively registered, http://www. chictr.org.cn/showproj.aspx?proj=23121n effective prevention and/or treatment strategy for cognitive impairment and dementia, especially in hypertensive patients with theAPOE epsilon 4 allele.