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Findings and implications of the Study on COgnition and Prognosis in the Elderly (SCOPE) – A review

The Study on Cognition and Prognosis in the Elderly (SCOPE) assessed the effect of candesartan on cardiovascular and cognitive outcomes in elderly patients (aged 70–89 years) with mild to moderate hypertension. Patients were randomized to treatment with candesartan 8–16 mg daily (n = 2477) or placebo (n = 2460) and followed for 3.7 years on average. In agreement with the study protocol, other antihypertensive drugs were added if blood pressure remained ⩾160 mHg systolic and/or ⩾90 mmHg diastolic. Due to extensive add‐on therapy, particularly in patients randomized to placebo, the between‐treatment difference in blood pressure was only 3.2/1.6 mmHg. Nevertheless, the main analysis showed that non‐fatal stroke was reduced by 28% (p = 0.04) in the candesartan group compared with the control group, and there was a non‐significant 11% reduction in the primary endpoint, major cardiovascular events (p = 0.19). This review article presents different predefined and post hoc analyses made so far. Of particular interest are significant risk reductions with candesartan in major cardiovascular events (32%, p = 0.013), cardiovascular mortality (29%, p = 0.049) and total mortality (27%, p = 0.018) in patients who did not receive add‐on therapy after randomization, and in whom the difference in blood pressure was 4.7/2.6 mmHg. Other analyses suggest positive effects of candesartan‐based treatment on cognitive function, quality of life and new‐onset diabetes. In conclusion, SCOPE strongly suggests that candesartan treatment reduces cardiovascular morbidity and mortality in old and very old patients with mild to moderate hypertension. Candesartan‐based antihypertensive treatment may also have positive effects on cognitive function and quality of life.