***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To assess if very elderly people with hypertension obtain early benefit from antihypertensive treatment . Design One year open label active treatment extension of r and omised controlled trial ( Hypertension in the Very Elderly Trial ( HYVET ) ) . Setting Hospital and general practice based centres mainly in eastern and western Europe , China , and Tunisia . Participants People on double blind treatment at the end of HYVET were eligible to enter the extension . Interventions Participants on active blood pressure lowering treatment continued taking active drug ; those on placebo were given active blood pressure lowering treatment . The treatment regimen was as used in the main trial — indapamide SR 1.5 mg ( plus perindopril 2 - 4 mg if required)—with the same target blood pressure of less than 150/80 mm Hg . Main outcome measures The primary outcome was all stroke ; other outcomes included total mortality , cardiovascular mortality , and cardiovascular events . Results Of 1882 people eligible for entry to the extension , 1712 ( 91 % ) agreed to participate . During the extension period , 1682 patient years were accrued . By six months , the difference in blood pressure between the two groups was 1.2/0.7 mm Hg . Comparing people previously treated with active drug and those previously on placebo , no significant differences were seen for stroke ( n=13 ; hazard ratio 1.92 , 95 % confidence interval 0.59 to 6.22 ) or cardiovascular events ( n=25 ; 0.78 , 0.36 to 1.72 ) . Differences were seen for total mortality ( 47 deaths ; hazard ratio 0.48 , 0.26 to 0.87 ; P=0.02 ) and cardiovascular mortality ( 11 deaths ; 0.19 , 0.04 to 0.87 ; P=0.03 ) . Conclusion Very elderly patients with hypertension may gain immediate benefit from treatment . Sustained differences in reductions of total mortality and cardiovascular mortality reinforce the benefits and support the need for early and long term treatment . Trial registration Clinical trials NCT00122811 OBJECTIVES To determine the prospect i ve relationship between blood pressure ( BP ) and cognitive function across a wide age range . DESIGN Prospect i ve population -based cohort study . SETTING The Rotterdam Study and the Leiden 85-plus Study . PARTICIPANTS Three thous and seventy-eight men and women , initial age 55 to 84 from the Rotterdam Study and 276 men and women , initial age 85 , from the Leiden 85-plus Study . MEASUREMENTS  Systolic BP ( SBP ) and diastolic BP ( DBP ) were measured at baseline , cognitive function was assessed at the end of follow-up using a dedicated neuropsychological test battery . The association between baseline BP levels and cognitive function later in life was assessed in 10-year age groups in the Rotterdam Study and in 85-year-olds of the Leiden 85-plus Study . RESULTS In the youngest participants ( < 65 ) , SBP and DBP were not associated with cognitive function 11 years later . For persons aged 65 to 74 , higher baseline SBP and DBP were related to worse cognitive function 11 years later . In contrast , in older age ( > or = 75 ) , higher SBP and DBP seemed to be related to better cognitive function at the end of follow-up . This effect appeared strongest in the highest age group ( aged 85 ) . CONCLUSION High BP was associated with greater risk of cognitive impairment in persons younger than 75 but with better cognitive function  in older persons . Age-specific guidelines for BP management are needed , because the current directive that " lower is better " may not apply to BP levels in the very old Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Results of previous studies of white older adults suggest that antihypertensive medications preserve cognition . We assessed the long-term effect of antihypertensive medications on cognitive function in a community sample of African American older adults . METHODS We conducted longitudinal surveys and clinical assessment of cognitive function in a r and om sample of 2212 community-dwelling African Americans 65 years and older . We identified 1900 participants without evidence of cognitive impairment at baseline , 1617 of whom had subsequent follow-up information , and 946 of whom had blood pressure measurements .  Cognitive function was measured at baseline and at 2 and 5 years by means of scores on the Community Screening Instrument for Dementia and neuropsychological and clinical assessment for dementia and cognitive impairment . Prescription and nonprescription medication use was derived from in-home inspection of medications and participant and informant reports . RESULTS Of 1900 participants , 288 ( 15.2 % ) developed incident cognitive impairment . Using logistic regression to control for the effects of age , sex , education , baseline cognitive scores , and hypertension and angina or myocardial infa rct ion , we found that antihypertensive medications reduced the odds of incident cognitive impairment by 38 % ( odds ratio , 0.62 ; 95 % confidence interval , 0.45 - 0.84 ) . Corresponding analysis using blood pressure measurements on the subset of participants was inconclusive . CONCLUSION Antihypertensive medication use is associated with preservation of cognitive function in older African American adults Objective : To determine the associations between classes of antihypertensive medication use and the risk of cognitive impairment  among elderly hypertensive men . Methods : The Honolulu-Asia Aging Study is a prospect i ve , community-based cohort study of Japanese American men conducted in Honolulu , Hawaii . We examined 2,197 participants ( mean age 77 years at cohort entry , 1991–1993 , followed through September 2010 ) with hypertension and without dementia or cognitive impairment at baseline , who provided information on medication use .  Cognitive function was assessed at 7 st and ardized examinations using the Cognitive Abilities Screening Instrument ( CASI ) . Cognitive impairment was defined as a CASI score < 74 . Results : A total of 854 men developed cognitive impairment  ( median follow-up , 5.8 years ) . β-Blocker use as the sole antihypertensive drug at baseline was consistently associated with a lower risk of cognitive impairment ( incidence rate ratio [ IRR ] 0.69 ; 95 % confidence interval [ CI ] 0.50–0.94 ) , as compared with men not taking any antihypertensive medications , adjusting for multiple potential confounders . The use of diuretics , calcium channel blockers , angiotensin-converting enzyme inhibitors , or vasodilators alone was not significantly associated with cognitive impairment . Results were similar excluding those with cardiovascular disease or < 1 year of follow-up , and additionally adjusting for pulse pressure , heart rate , baseline and midlife systolic blood pressure , and midlife antihypertensive treatment ( IRR 0.65 ; 95 % CI 0.45–0.94 ) . The association between β-blocker use and cognitive impairment was stronger among men with diabetes , men aged > 75 years , and those with pulse pressure ≥70 mm Hg . Conclusions : β-blocker use is associated with a lower risk of developing cognitive impairment in elderly Japanese American men BACKGROUND Whether the treatment of patients with hypertension who are 80 years of age or older is beneficial is unclear . It has been suggested that antihypertensive therapy may reduce the risk of stroke , despite possibly increasing the risk of death . METHODS We r and omly assigned 3845 patients from Europe , China , Australasia , and Tunisia who were 80 years of age or older and had a sustained systolic blood pressure of 160 mm Hg or more to receive either the diuretic indapamide ( sustained release , 1.5 mg ) or matching placebo .  The angiotensin-converting-enzyme inhibitor perindopril ( 2 or 4 mg ) , or matching placebo , was added if necessary to achieve the target blood pressure of 150/80 mm Hg . The primary end point was fatal or nonfatal stroke . RESULTS The active-treatment group ( 1933 patients ) and the placebo group ( 1912 patients ) were well matched ( mean age , 83.6 years ; mean blood pressure while sitting , 173.0/90.8 mm Hg ) ; 11.8 % had a history of cardiovascular disease . Median follow-up was 1.8 years . At 2 years , the mean blood pressure while sitting was 15.0/6.1 mm Hg lower in the active-treatment group than in the placebo group . In an intention-to-treat analysis , active treatment was associated with a 30 % reduction in the rate of fatal or nonfatal stroke ( 95 % confidence interval [ CI ] , -1 to 51 ; P=0.06 ) , a 39 % reduction in the rate of death from stroke ( 95 % CI , 1 to 62 ; P=0.05 ) , a 21 % reduction in the rate of death from any cause ( 95 % CI , 4 to 35 ; P=0.02 ) , a 23 % reduction in the rate of death from cardiovascular causes ( 95 % CI , -1 to 40 ; P=0.06 ) , and a 64 % reduction in the rate of heart failure ( 95 % CI , 42 to 78 ; P<0.001 ) . Fewer serious adverse events were reported in the active-treatment group ( 358 , vs. 448 in the placebo group ; P=0.001 ) . CONCLUSIONS The results provide evidence that antihypertensive treatment with indapamide ( sustained release ) , with or without perindopril , in persons 80 years of age or older is beneficial . ( Clinical Trials.gov number , NCT00122811 [ Clinical Trials.gov ] . ) Background : Recent interest in antihypertensive agents , especially calcium channel blockers , has been sparked by the notion that these medications may be neuroprotective . A modest literature , with mixed results , has examined whether these medications might lower the odds or risk of Parkinson ’s disease ( PD ) or dementia . There are no data for essential tremor ( ET ) . Objective : To examine the association between antihypertensive use ( defined broadly and by individual subclasses ) and ET , PD and dementia . For each disorder , we used cross-sectional data ( association with prevalent disease ) and prospect i ve data ( association with incident disease ) . Methods : Prospect i ve population -based study in Spain enrolling 5,278 participants at baseline . Results : Use of antihypertensive medications ( aside from β-blockers ) was similar in prevalent ET cases and controls . Baseline use of antihypertensive agents was not associated with reduced risk of incident ET . Antihypertensive medication use was not associated with prevalent or incident PD . Calcium channel blocker use was marginally reduced in prevalent dementia cases ( ORadjusted = 0.63 , p = 0.06 ) but was not associated with reduced risk of incident dementia ( RRadjusted = 1.02 , p = 0.95 ) . Conclusions : We did not find evidence of a protective effect of antihypertensive medications in these three neurodegenerative disorders BACKGROUND Observational epidemiological studies have shown a positive association between hypertension and risk of incident dementia ; however , the effects of antihypertensive therapy on cognitive function in controlled trials have been conflicting , and meta-analyses of the trials have not provided clear evidence of whether antihypertensive treatment reduces dementia incidence . The Hypertension in the Very Elderly trial ( HYVET ) was design ed to assess the risks and benefits of treatment of hypertension in elderly patients and included an assessment of cognitive function . METHODS Patients with hypertension ( systolic pressure 160 - 200 mm Hg ; diastolic pressure < 110 mm Hg ) who were aged 80 years or older were enrolled in this double-blind , placebo-controlled trial . Participants were r and omly assigned to receive 1.5 mg slow release indapamide , with the option of 2 - 4 mg perindopril , or placebo . The target systolic blood pressure was 150 mm Hg ; the target diastolic blood pressure was 80 mm Hg . Participants had no clinical diagnosis of dementia at baseline , and cognitive function was assessed at baseline and annually with the mini-mental state examination ( MMSE ) . Possible cases of incident dementia ( a fall in the MMSE score to < 24 points or a drop of three points in 1 year ) were assessed by st and ard diagnostic criteria and expert review . The trial was stopped in 2007 at the second interim analysis after treatment result ed in a reduction in stroke and total mortality . Analysis was by intention to treat . The trial is registered with Clinical Trials.gov , number NCT00122811 . FINDINGS 3336 HYVET participants had at least one follow-up assessment ( mean 2.2 years ) and were included : 1687 participants were r and omly assigned to the treatment group and 1649 to the placebo group . Only five reports of adverse effects were attributed to the medication : three in the placebo group and two in 
    Output:
    
At present , there is no clear evidence to suggest that CCB use increases or decreases risk of cognitive decline or dementia in the very elderly .