Objective To investigate the clinical efficacy of β-blockers in older patients with hypertension combined with vascular dementia.

Methods A total of 152 older patients with hypertension combined with vascular dementia who were admitted to Shanxi Provincial Fenyang Hospital between January 2022 and October 2024 were enrolled. The participants were randomly assigned to either the study group or the control group (76 patients each) using the randomized numerical table method. Both groups received conventional treatment, and the study group received metoprolol for 5 weeks in addition to the conventional treatment. Primary outcome indicators, including changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after treatment, were examined. Additionally, comparison was made to examine the intergroup difference in serological markers, including high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8, matrix metalloproteinase 9 (MMP-9), homocysteine (Hcy), and superoxide dismutase (SOD) levels, and the scores for intelligence, cognitive, and behavioral assessments. Adverse reactions were recorded.

Results After treatment, the study group showed reduced SBP from (146.90 ± 7.35) mmHg (1 mmHg = 0.133 kPa) to (120.00 ± 6.03) mmHg and reduced DBP from (90.24 ± 5.97) mmHg to (77.23 ± 6.81) mmHg. The reduction in blood pressure in the study group became more significantly when compared with that of the control group, with intergroup difference in SBP reduction being －8.54 mmHg (P < 0.001) and intergroup difference in DBP reduction being －10.80 mmHg (P < 0.001). Patients in the 2 groups showed statistically significant differences in the levels of hs-CRP, TNF-α, IL-6, IL-8, MMP-9, and Hcy, and in their cognitive and behavioral scores (P < 0.05). No statistically significant differences were found in pulse pressure, von Willebrand factor (vWF) levels, or intelligence scores before and after treatment (P > 0.05). The main adverse reactions in the study group were central nervous system reactions (22.37%) and withdrawal syndrome (17.11%).

Conclusion The β-blocker metoprolol effectively controlled blood pressure, significantly reduced levels of pro-inflammatory factors and specific vascular injury markers, and improved cognitive function and behavioral symptoms in older patients with hypertension combined with vascular dementia, suggesting its therapeutic efficacy for this condition. However, attention should be paid to its associated adverse reactions.