Background: Hypertension is strongly associated with cognitive decline and a promising target for dementia prevention. Our aim was to investigate the association between different antihypertensive treatments and cognitive performance in elderly hypertensive patients presenting with subjective memory complaints (SMC).

Patients and methods: 378 elderly hypertensive patients > 60 years (mean age 70.4 ± 6.3 years) treated with at least one antihypertensive agent and presenting with SMC but without dementia were prospectively recruited and underwent a combination of neuropsychological tests, a brain magnetic resonance imaging with semi-quantification of White Matter Hyperintensities (WMH), carotid echotracking, brachial endothelial function and ambulatory blood pressure (BP) assessments.

Results: None of the 3 composite scores (Memory score, verbal fluency, visual memory capacity) was found associated with BP levels. On the other hand, age and gender-adjusted analyses showed a significant and positive association between memory score and calcium channel blockers (CCBs) use (users: +0.14 ± 0.09 versus non-users: −0.12± 0.06, p = 0.016). Multivariate analyses also revealed that CCBs use was significantly associated with a better memory score, independently from age, male gender, WMH and carotid wall cross-sectional area, all of which were associated with worse memory scores.

Conclusions: In elderly hypertensive treated patients with SMC, CCBs use was associated with better memory performances independently of BP level and macro and microvascular alterations, suggesting a specific neuroprotective effect of this pharmacological class. Interventional controlled trials are required to confirm the specific protective effect of CCBs on cognitive decline.