AIM  To compare the effect of amlodipine plus irbesartan and amlodipine plus metoprolol on blood pressure and cognitive function in elderly hypertension.

  METHODS  A total of 198 elderly patients with grade 2 hypertension and mild cognitive impairment who were treated in the First Affiliated Hospital of Air Force Medical University from 2018 to 2021, aged (65 to 79) years, were randomly divided into irbesartan group (amlodipine besylate combined with irbesartan tablets, n=98) and metoprolol group (amlodipine besylate combined with metoprolol succinate, n=100). The blood pressure was measured at the 4th, 8th, 12th and 24th weeks of medication, and a questionnaire survey was conducted with the Montreal Cognitive Assessment (MoCA) before and after treatment. MoCA<26 was defined as MCI, and blood pressure <140/90 mmHg (1 mmHg=0.133 kPa) was the standard for blood pressure compliance.

  RESULTS  There was no statistical difference between the two groups in terms of basic information. There was no statistical difference between the two groups in terms of the rate of reaching the antihypertensive goal at the 4th, 8th, 12th and 24th weeks. Compared with that at the time of inclusion, the systolic and diastolic blood pressure of the two groups decreased at the 4th, 8th, 12th and 24th weeks. The longer the medication was, the greater the reduction was, both P<0.05, but there was no statistically significant difference between the two groups. MoCA score in irbesartan group was significantly higher than that before treatment (P<0.01), and MoCA score in metoprolol group was significantly higher after treatment (P<0.01). There was no significant difference in MoCA score before and after treatment in metoprolol group.

  CONCLUSION  Amlodipine plus irbesartan or metoprolol for 24 weeks equally reduces blood pressure and the former is superior to the latter on cognitive function improvement in this patient cohort.