Abstract
BackgroundThe role of hypertension in the loss of cognitive function is controversial. Relationships between hypertension and increases in cerebral vascular resistance, diffused lesions and multiple lacunar infarcts of the white matter are well known. Thus, the objectives of this study were: to evaluate the relationship between hypertension and cognitive dysfunction (CD), identify risk factors and determine the association between early markers of vascular disease and CD in hypertensive individuals.MethodsTwo hundred individuals aged between 40 and 80 years old were evaluated in this cross-sectional prospective study. Fifty participants were controls (CT). The remaining 150 hypertensive patients were subdivided into two groups, those with CD (HCD) and those without CD (HNCD). All participants underwent clinical evaluations and biochemical blood tests were performed. CD was investigated using the Mini Mental State Examination (MMSE) following the guidelines for its use in Brazil. The impact of hypertension on the arterial bed was assessed by identifying and measuring changes in the intima-media thickness (IMT) by vascular ultrasonography of the carotid arteries and analyses of the central blood pressure and Augmentation Index by applanation tonometry of the radial artery.ResultsThere were no significant differences in the total cholesterol, high-density lipoprotein cholesterol and triglycerides plasma concentrations between the three groups. The serum creatinine and estimated glomerular filtration rate were within normal ranges for all three groups. A significantly lower MMSE score was recorded for the HCD Group compared to the HNCD and CT Groups (p-value < 0.05).The IMT was significantly different between the HNCD and HCD Groups (p-value = 0.0124). A significant difference in the IMT was also observed between hypertensive patients and the CT Group (p-value < 0.0001). Age, low-density cholesterol, high-density cholesterol, triglycerides and IMT increased the Odds Ratio for cognitive dysfunction.The central systolic pressure was significantly higher in the HCD and HNCD Groups compared to CT Group (p-value < 0.0001).ConclusionsHypertensive patients with CD have changes in the vascular morphology characterized by an increased carotid IMT, enhanced atherosclerotic lipid profile and impaired hemodynamic functional manifested by elevated central systolic blood pressure.
Highlights
Hypertension is a major risk factor for cardiovascular disease including strokes, coronary heart disease [1,2,3], left ventricular hypertrophy, congestive heart failure [4,5,6], aortic dissection [7,8,9], renal failure [10,11,12] and peripheral vascular disease [13]
No significant differences were found between the two hypertensive subgroups in relation to the duration of hypertension (HCD = 15.03 ± 9.74 vs. HNCD 15.73 ± 9.57 - p-value = 0.40) and in relation to the use of different anti-hypertensive drug classes (Table 1)
The mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP and pulse pressure (PP) in the HCD and HNCD groups measured during outpatient visits were all higher than in the CT group
Summary
Hypertension is a major risk factor for cardiovascular disease including strokes (especially hemorrhagic), coronary heart disease (myocardial infarction) [1,2,3], left ventricular hypertrophy, congestive heart failure [4,5,6], aortic dissection [7,8,9], renal failure [10,11,12] and peripheral vascular disease [13]. It is well known that hypertension is associated to increased cerebral vascular resistance with diffuse lesions and multiple lacunar infarcts in the white matter (especially in the subcortical region) that are histopathologically detectable and visible by magnetic resonance imaging [21,22,23]. Such infarcts have been linked to dementia in the elderly [24]. Relationships between hypertension and increases in cerebral vascular resistance, diffused lesions and multiple lacunar infarcts of the white matter are well known. The objectives of this study were: to evaluate the relationship between hypertension and cognitive dysfunction (CD), identify risk factors and determine the association between early markers of vascular disease and CD in hypertensive individuals
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