RAAS Inhibitors in the Cardiovascular Continuum: What is Still Missing?
The Study on Cognition and Prognosis in the Elderly (SCOPE) was designed to provide outcome data on cardiovascular endpoints and cognitive function in 4500 elderly hypertensive patients randomised to the angiotensin receptor blocker, candesartan, or to placebo and followed up for 4.5 years. The primary endpoint of combined cardiovascular mortality, non-fatal myocardial infarction and non-fatal stroke was not significantly reduced by active treatment (relative risk reduction 11%, p=0.19). There was also no significant difference in the decline of cognitive function between the two treatment arms. Active treatment of the placebo group (mainly hydrochlorothiazide) reduced the blood pressure differences between the treatment arms to only 3.2/1.6 mmHg, thus markedly reducing the overall power of the study. In a number of non-prespecified subgroup analyses, advantages of candesartan over placebo were reported.