Abstract 71: Cognitive Impairment And The Risk Of Incident Stroke In Hypertensive Patients

Abstract

Background: Research has shown that post-stroke cognitive impairment is associated with worse functional outcome and stroke recurrence, but has not fully explored if cognitive impairment is associated with the risk of first-ever clinical stroke. Methods: We performed a post-hoc analysis of non-stroke SPRINT trial participants randomized to either a systolic blood pressure target <140mm Hg versus <120mm Hg. The primary outcome was incident stroke (ischemic and hemorrhagic). The study exposure was the baseline Montreal Cognitive Assessment (MoCA) score, into categories of <20, 20-25, and 26-30. We fit Cox models adjusting for age, race, sex, randomization arm, baseline blood pressure, atrial fibrillation, prior TIA, diabetes, and smoking. We verified the proportional hazards assumption of our Cox model. Results: We included 9126 patients (mean age 67.9, males 64.4%, non-Hispanic white 57.8%), of which 169 (1.8%) developed incident stroke during a mean follow-up of 3.8±0.9 years. The rate of stroke in the MoCA categories was 32/2713 (1.2%) for MoCA 26-30, 85/4649 (1.8%) for MOCA 20-25, and 50/1764 (2.8%) for MoCA <20 (p<0.001). In the adjusted Cox model, compared to the reference of MoCA 26-30, the hazard ratio for stroke was 1.42 (95% CI 0.94-2.14, p=0.099) in MoCA 20-25 and 2.22 (95% CI 1.38-3.56, p=0.001) in MoCA <20. The Kaplan-Meier curve for the MoCA stratification is presented in Figure 1. Conclusion: Severe cognitive impairment (MoCA <20) is a significant risk factor for incident stroke in hypertensive patients. Further research is needed to understand the mediators of this observation, in particular the control of vascular risk factors during follow-up.