The association between cognitive decline and short-term blood pressure variability in middle-aged patients with primary hypertension — a pilot study

Abstract

Introduction. Hypertension (HTN) is a common cause of cognitive dysfunction. Current data emphasize a role of HTN in the development of unfavourable vascular remodelling and changes in cerebral microcirculation, leading to cognitive decline. In this study, we sought associations between circadian blood pressure variability (BPV) in a 24h blood pressure ambulatory monitoring (ABPM) and cognitive decline in middle-aged hypertensive patients. Material and methods. The study group comprised 42 patients with uncomplicated hypertension (24 females, 18 males; mean age: 59.1 ± 6.1 years). BPV was assessed by ABPM and expressed in standard deviation (24 MAP SD) and coefficient of variation (CV). Cognitive performance was evaluated using Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT) and Montreal Assessment Cognitive Scale (MoCA). Results. In the whole study group, MMSE and CDT scores were within the normal range, but the mean scores were lowered in the MoCA test. All of the neuropsychological test scores were comparable in groups with normal and abnormal (non-dipper) blood pressure patterns. Among the analyzed BPV indicators, CV was negatively correlated with CDT and MoCA scores. 24 MAP expressed in standard deviations was also negatively correlated with CDT scores. In the multivariate analysis, MoCA scores were inversely associated with CV after adjusting for age, gender, education and abnormal lipid profiles. Mean MoCA scores were significantly lower in men in comparison to women. Conclusions. In this pilot-based study, mild cognitive impairment in middle-aged patients with long-lasting uncomplicated hypertension may be associated with increased diurnal variability of blood pressure.