Cognitive Function In Hypertensive Patients Research Articles

Effect of Lavender Oil Leg Massage on Physical, Cognitive, and Psychological Variables of Patients with Hypertension: A Randomized Controlled Trial.

Hypertension (HTN) is one of the most important non-communicable risk factors that cause cardiovascular diseases. Complementary therapies including massage and aromatherapy are widely used in the management of HTN. However, studies on aromatherapy massage in HTN are limited. Thus, this study was conducted to evaluate the effect of lavender oil leg massage on physical (cardiopulmonary function), cognitive, and psychological variables of patients with HTN. A parallel-group randomized controlled trial, comprising 100 HTN patients aged 44.99 ± 5.39 years who were recruited and randomly divided into the study group (SG) and control group (CG), was conducted. The SG received lavender oil leg massage, while the CG received supine rest for 20 min. Outcome variables like blood pressure (BP), pulse rate (PR), random blood sugar (RBS) level, oxygen saturation, pulmonary function, oral temperature, trail making test (TMT) A and B, and state anxiety and mindfulness were assessed before and after the intervention. The within-group analysis showed a significant improvement in systolic blood pressure, diastolic blood pressure, PR, RBS, TMT-A, TMT-B, and state mindfulness both in the SG and CG. However, a significant reduction in state anxiety was observed only in the SG unlike the CG. Moreover, the between-group analysis showed a significant improvement in state mindfulness and state anxiety in the SG compared to the CG. The results of this study suggest that lavender oil leg massage is effective in reducing BP and RBS, and improving cognitive function in hypertensive patients. In addition, it is more effective in reducing anxiety and improving mindfulness than rest in supine position in patients with HTN.

Association between intensity of physical activity and cognitive function in hypertensive patients: a case–control study

Previous studies have shown that a higher intensity of physical activity (PA) is associated with a lower risk of cognitive impairment (CI), whereas hypertension is associated with higher CI. However, there are few studies on the association between PA intensity and cognitive function in hypertensive patients. This study investigated the association between PA intensity and cognitive function in hypertensive patients. A total of 2035 hypertensive patients were included in this study, including 407 hypertensive patients with CI and 1628 hypertensive patients with normal cognitive function matched 1:4 by age and sex. The International Physical Activity Questionnaire-Long Form and the Mini-mental State Examination were used to evaluate PA intensity, total metabolic equivalents, and cognitive function in patients with hypertension. Multivariate logistic regression was used to analyze the correlation between PA intensity and CI in hypertensive patients. The Spearman correlation coefficient was used to analyze the correlation between PA intensity and the total score of each component of the MMSE and the correlation between PA total metabolic equivalents and cardiac structure in hypertensive patients. After adjusting for all confounding factors, PA intensity was negatively associated with CI in hypertensive patients (OR = 0.608, 95% CI: 0.447–0.776, P < 0.001), and this association was also observed in hypertensive patients with education level of primary school and below and junior high school and above (OR = 0.732, 95% CI: 0.539–0.995, P = 0.047; OR = 0.412, 95% CI: 0.272–0.626, P < 0.001). The intensity of PA in hypertensive patients was positively correlated with orientation (r = 0.125, P < 0.001), memory (r = 0.052, P = 0.020), attention and numeracy (r = 0.151, P < 0.001), recall ability (r = 0.110, P < 0.001), and language ability (r = 0.144, P < 0.001). PA total metabolic equivalents in hypertensive patients were negatively correlated with RVEDD and LAD (r = − 0.048, P = 0.030; r = − 0.051, P = 0.020) and uncorrelated with LVEDD (r = 0.026, P = 0.233). Higher PA intensity reduced the incidence of CI in hypertensive patients. Therefore, hypertensive patients were advised to moderate their PA according to their circumstances.

Edukasi Mengenai Gangguan Kognitif Pada Pasien Hipertensi di Poli Neurologi Rumah Sakit Universitas Mataram

Cognitive impairment in hypertensive patients is a significant clinical problem. It is a prevalent condition that has a major impact on quality of life. Hypertension, characterized by persistently elevated blood pressure, has been identified as a potential risk factor for cognitive impairment. Assessing cognitive function in hypertensive patients is essential for early detection and intervention. Community participation is crucial to raise awareness about the symptoms of cognitive impairment in hypertensive patients. Therefore, education on cognitive impairment associated with hypertension is necessary to reduce its morbidity. This community service activity aims to provide education on the definition, signs, and symptoms, as well as early detection methods of cognitive impairment in hypertensive patients to patients and their families at the neurology clinic University of Mataram Hospital. The activity was conducted using an interactive method with the aid of PowerPoint slides. The participants were given a pre-test, followed by a presentation on the disease, a discussion session, and finally, a post-test. There were 14 participants in total. The education session began with a pre-test consisting of five questions about cognitive impairment and hypertension. The participants' average score was 74.2. The material covered definitions, symptoms, early signs, and how to conduct early detection of cognitive impairment and hypertension. The education session concluded with a post-test, which revealed that 10 participants (71.4%) showed an increase in their knowledge scores, with a mean score of 88.5. Effective communication, information, and education are essential in improving knowledge about the early detection of cognitive impairment in hypertensive patients.

Mild traumatic brain injury-induced persistent blood–brain barrier disruption is prevented by cyclosporine A treatment in hypertension

IntroductionMild traumatic brain injury (mTBI) and hypertension synergize to induce persistent disruption of the blood–brain barrier (BBB), neuroinflammation and cognitive decline. However, the underlying mechanisms are not known. Cerebral production of Cyclophilin A (CyPA) is induced in hypertension and after TBI, and it was demonstrated to activate the nuclear factor-κB (NF-kB)- matrix-metalloproteinase-9 (MMP-9) pathway in cerebral vessels leading to BBB disruption.MethodsTo test the role of CyPA in mTBI- and hypertension-induced BBB disruption we induced mTBI in normotensive and spontaneously hypertensive rats (SHR), then the animals were treated with cyclosporine A (a specific inhibitor of CyPA production) or vehicle for 7 days. We assessed BBB permeability and integrity, cerebral expression and activity of the CyPA-NF-kB-MMP-9 pathway, extravasation of fibrin and neuroinflammation.ResultsWe found that mild TBI induced BBB disruption and upregulation of the CyPA-NF-kB-MMP-9 pathway in hypertension, which were prevented by blocking CyPA. Cyclosporine treatment and preservation of BBB function prevented accumulation of blood-derived fibrin in the brain parenchyma of hypertensive rats after mTBI and reversed increased neuroinflammation.DiscussionWe propose that mTBI and hypertension interact to promote BBB disruption via the CyPA-NF-kB-MMP-9 pathway, and inhibition of cyclophilin production after mTBI may exert neuroprotection and improve cognitive function in hypertensive patients.

FEATURES OF COGNITIVE FUNCTIONS IN HYPERTENSIVE PATIENTS WITH THE PRESENCE/ABSENCE OF CHRONIC HEART FAILURE

Objective: to evaluate cognitive functions in hypertensive patients with the presence/absence of chronic heart failure (CHF). Design and method: 100 male and female patients with I-III degree of arterial hypertension (AH) (ESH / ESC, 2018), who are on outpatient treatment at Republican Specialized Scientific and Practical Medical Center of Cardiology, were examined. The stage of CHF was diagnosed according to classification (ESH / ESC, 2020), the exclusion criteria was CHF stage IIB-III. The mean age of patients was 55.8±12.2 years, AH duration was 9.4±6.7 years. All patients initially measured office systolic blood pressure (SBP) and diastolic blood pressure (DBP). Cognitive functions were evaluated using neuro-psychological tests: the Mini-Cog test, Montreal Cognitive Assessment (MoCA). The hospital anxiety and depression scale (HADS) was used to assess levels of anxiety and depression. The results are presented as M ± SD. Results: All patients were divided into two groups: 1 - patients with AH without CHF (n = 78) and 2 - patients with AH with CHF stage I-IIA (n = 22). The analysis of cognitive functions in AH patients revealed good indicators of cognitive functions in AH patients without CHF in comparison with AH patients with stage I-IIA CHF. In particular, the overall score on the Mini-Cog test: in 1st group it was 4.05±0.92 points, in 2nd group - 3.45±1.4 points (p&lt;0.05), the drawing function was much better: 1.72±0.55 points versus 1.4±0.85 points (p&lt;0.05). The total score on the MOCA scale was slightly higher in group 1 than in group 2: 24.59±2.65 versus 23.31±3.83 points, p = 0.075. At the same time, self-assessment of attention was better in 1st group than in 2nd group: 8.76±1.51 versus 7.84±2.46 points, p&lt;0.05. Visual-constructive performance skills were also better in group 1 than in group 2: 4.13±1.05 versus 3.5±1.47 points, p&lt;0.05. Coping with work in the 1st group of patients was somewhat better than in the 2nd group: 9.09±1.37 versus 8.31±2.39 points, p = 0.072. Conclusions: Thus, in hypertensive patients with CHF stage I-IIA is noted the severity of cognitive impairment, in contrast to patients without CHF.

Research progress on the correlation between sacubitril-valsartan and cognitive function in hypertensive patients

Sacubitril-valsartan can exert antihypertensive effects by blocking the effect of angiotensin Ⅱ and inhibiting the activity of enkephalinase. As a currently common antihypertensive drug, sacubitril-valsartan’s protective effects on target organs have been confirmed in more and more studies. Inhibition of enkephalinase can hinder the degradation and metabolism of beta-amyloid, deposition of which is a characteristic pathological feature of Alzheimer's disease. And hypertension itself is a risk factor for cognitive dysfunction, so long-term medications have the theoretical possibility to result in adverse effects on the cognitions of hypertensive patients. A review of various perspectives towards the effects of sacubitril-valsartan on cognitive function in patients with hypertension will be delivered.

Association Between Lipid Accumulation Product and Cognitive Function in Hypertensive Patients With Normal Weight: Insight From the China H-type Hypertension Registry Study.

BackgroundHypertension is a major cardiovascular risk factor for cognitive impairment. Lipid accumulation product (LAP), an index that represents fat overaccumulation in the body, has been shown to be associated with cardiovascular disease. Nevertheless, the relationship between LAP and cognitive function in hypertensive patients with normal weight has been infrequently studied.ObjectiveThis study aimed to assess the relationship between LAP and cognitive function in hypertensive patients with normal weight.MethodsThis study included 5,542 Chinese hypertensive patients with normal weight. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). The relationship between LAP and MMSE scores was evaluated using multiple linear regression.ResultsThe mean age of the participants was 64.8 ± 9.3 years, and 2,700 were men (48.7%). The mean MMSE score was 24.5 ± 5.1 in men and 19.2 ± 6.5 in women. The mean LAP was 26.2 ± 25.5 in men and 42.5 ± 34 in women. Log10-LAP showed a significant positive association with MMSE score (men: β = 0.69, 95% CI 0.14–1.24, p = 0.015; women: β = 1.03, 95% CI 0.16–1.90, p = 0.020). When LAP was divided into 3 groups according to tertiles, participants in the third LAP tertile had higher MMSE scores for both men (p for trend = 0.04) and women (p for trend = 0.015).ConclusionLAP showed an independent positive association with MMSE in Chinese hypertensive patients with normal weight.

Взаимосвязь структурно-функциональных изменений левых отделов сердца с когнитивными функциями у пациентов с артериальной гипертензией

Цель — выяснить особенности связи между структурно-функциональными изменениями левых отделов сердца и когнитивными функциями у пациентов с артериальной гипертензией (АГ). Материалы и методы. Обследовано 90 больных АГ I–II стадий, 2–3-й степени (средний возраст 49,66 ± 8,74 года). Для объективизации когнитивных нарушений (КН) проводились нейропсихологические тестирования: шкала оценки когнитивных функций врачом общей практики (GPCOG), краткая шкала исследования психического статуса (Mini-Mental State Examination — MMSE), таблицы Шульте. По данным MMSE, суммарное количество набранных баллов 24–26 оценивалось как КП. Структурно-функциональное состояние сердца оценивали с помощью эхокардиографии. В ходе исследования сравнивали показатели тестов среди пациентов с АГ, у которых обнаружили гипертрофию левого желудочка (ГЛЖ), с пациентами с АГ и нормальным индексом массы миокарда ЛЖ (ИММЛЖ). ГЛЖ констатировали при наличии ИММЛЖ ≥ 95 г/м2 у женщин и ≥ 115 г/м2 у мужчин. Результаты. У пациентов с АГ и гипертрофией ЛЖ существенно чаще выявляли когнитивные расстройства (48,08 против 28,95 %, р &lt; 0,05). Сумма баллов по нейропсихологических шкалам у таких пациентов достоверно обратно коррелировала с ИММЛЖ (r = –0,40, р = 0,01), толщиной межжелудочковой перегородки (r = –0,55, р = 0,01), толщиной задней стенки ЛЖ (r = –0,49, р = 0,01). Установлены также достоверная обратная корреляционная зависимость между диастолической дисфункцией ЛЖ и суммой баллов по шкалам MMSE и GPCOG (r = –0,63 и r = –0,58 соответственно, р = 0,001 для обеих шкал) и прямая зависимость со временем выполнения пробы Шульте (r = 0,39, р = 0,01). Выводы. Структурно-функциональные изменения ЛЖ, а именно гипертрофия ЛЖ и его диастолическая дисфункция существенно ассоциируются с когнитивными расстройствами у больных АГ. У таких пациентов значительно ниже показатели нейропсихологических тестов, особенно чувствительными оказались домены памяти и счета.

Exosomal MicroRNAs Contribute to Cognitive Impairment in Hypertensive Patients by Decreasing Frontal Cerebrovascular Reactivity.

Mechanisms underlying cognitive impairment (CI) in hypertensive patients remain relatively unclear. The present study aimed to explore the relationship among serum exosomal microRNAs (miRNAs), cerebrovascular reactivity (CVR), and cognitive function in hypertensive patients. Seventy-three hypertensive patients with CI (HT-CI), 67 hypertensive patients with normal cognition (HT-NC), and 37 healthy controls underwent identification of exosomal miRNA, multimodal magnetic resonance imaging (MRI) scans, and neuropsychological tests. CVR mapping was investigated based on resting-state functional MRI data. Compared with healthy subjects and HT-NC subjects, HT-CI subjects displayed decreased serum exosomal miRNA-330-3p. The group difference of CVR was mainly found in the left frontal lobe and demonstrated that HT-CI group had a lower CVR than both HT-NC group and control group. Furthermore, both the CVR in the left medial superior frontal gyrus and the miRNA-330-3p level were significantly correlated with executive function (r = −0.275, P = 0.021, and r = −0.246, P = 0.04, respectively) in HT-CI subjects, and the CVR was significantly correlated with the miRNA-330-3p level (r = 0.246, P = 0.040). Notably, path analysis showed that the CVR mediated the association between miRNA-330-3p and executive function. In conclusion, decreased miRNA-330-3p might contribute to CI in hypertensive patients by decreasing frontal CVR and could be a biomarker of early diagnosis.

Why Should We Must Evaluate Cognitive Function in Hypertensive Patients

Why Should We Must Evaluate Cognitive Function in Hypertensive Patients

Cognitive functions in patients suffering from hypertension and hypothyroidism with retrospective evaluation of control over disease compensation.

The aim of the study was to study the status of cognitive functions in hypertensive patients, patients with hypothyroidism, and in patients with combination of these diseases, taking into account the state of disease compensation. 67 patients (36 men and 31 women), average age – 49.84±2.83 years were examined. The control group (CG) consisted of 18 practically healthy individuals (8 men and 10 women). Patients who received appropriate nosology treatment were divided into 3 groups: Group I – 21 patients with hypertension, systolic blood pressure (SBP) – 134.26±5.23 mm Hg, diastolic blood pressure (DBP) – 84.37±4.51 mm Hg; Group II – 18 patients with hypothyroidism, thyrotropic hormone (TSH) – 3.16±0.79 mIU/L, stage of hypothy­roidism compensation was diagnosed in 83.3%, subcompensation – in 16.7%; Group III – 28 patients with hyper­ten­sion (SBP 145.52±5.45 mm Hg; DBP 82.41±3.86 mm Hg) with concomitant hypothyroidism (TSH – 2.92±0.78 mIU/L, stage of compensation for hypothyroidism was diagnosed in 85.7%, subcompensation – in 14.3% of cases. Information about visits to the therapist/cardiologist/family doctor and endocrinologist was used to analyze the therapeutic correction of the disease: ambulatory medical records of patients with measurement of blood pressure (BP) and TSH during the disease were processed. To assess cognitive functions, Mini Mental State Examination (MMSE) and the Addenbrooke’s cognitive examination (ACE-R) were used. The relationship of average blood pressure data in patients with hypertension and TSH in patients with hypothyroidism during the disease period and the level of cognitive function was investigated. The average level of office BP (SBP/DBP) in Groups I and III compared to CG during the examination was: SBP 134.26±5.23 mm Hg (p=0.047), DBP 84.37±4.51 mm Hg (p=0.041) in Group I; SBP 145.52±5.45 mm Hg (p=0.031), DBP 82.41±3.86 mm Hg (p=0.050) in Group III. Analyzing the TSH levels it was found that at the time of the physical examination of patients in Group II the TSH was 3.16±0.79 mIU/L (p=0.009), the stage of compensation was diagnosed in 83.3%, subcompensation – in 16.7%; in Group III the TSH was 2.92±0.78 mIU/L (p=0.027), the stage of hypothyroidism compensation was diagnosed in 85.7%, subcompensation – in 14.3%. When evaluating MMSE scores, the proportion of patients in Groups I-III who had cognitive impairment (CI) was 6.9%, 10.3% and 13.8% respectively. On individual assessment of ACE-R test scores, CI in Groups I-III was in 6.4%, 9.6% and 13.8% respectively. A detailed analysis of the patterns of the ACE-R scale revealed that patients in Group I had a significantly lower score in the memory domain (22.68±0.96, p=0.037); patients in Group II had a low score in the concentration domain (15.85±1.14, p=0.045) and executive functions domain (11.62±8.63, p=0.041). Taking into account the interaction of factors (hypertension and hypothyroidism), it was found that in 40% of patients in Group III the most affected cognitive domains were memory (21.12±0.98, p=0.012) and speech (22.41±2.32, p=0.038); 60% of patients had problems with executive functions (11.90±9.17, p=0.033) as well as with visual-spatial skills (14.40±8.15, p=0.045). MMSE test showed a significantly lower score in the memory domain (1.87±0.46, p=0.008) in Group I, patients of Group II had a significantly lower score in the concentration domain (2.53±0.54, p=0.018). Basing on the interaction of factors (hypertension and hypothyroidism), it was found that in 45% of patients the most affected cognitive domain was memory (2.3±0.38, p=0.028), and 55% suffer from impaired speech, praxis (7.48±0.59, p=0.018) and perception (2.45±0.67, p=0.028). A retrospective analysis of medical records regarding the control of patients’ diseases was conducted. It was found that the average level of SBP/DBP in Groups I and III was 154.38±5.11 (p=0.000) \ 96.47±3.49 (p=0.006) mm Hg; 158.26±5.64 (p=0.001) \ 98.42±4.93 (p=0.005) mmHg, respectively. The TSH level over the disease period in patients of Groups II and III was 7.14±2.37 mIU/L (p=0.002) and 8.03±3.77 mIU/L (p=0.000), respectively, which was different from the data obtained in the last study. Retrospective analysis of medical records made it possible to establish a real long-term control of blood pressure, TSH in patients with hypertension, in patients with hypothyroidism and in patients with combination of these diseases, which caused CI in 6.9% of patients with hypertension, in 10.3% of patients with hypothyroidism and in 13.8% of patients with combined pathology based on MMSE test results. The ACE-R test results show the same sequence. Individual assessment of ACE-R test scores revealed CI in Groups I-III: 6.4%; 9.6% and 13.8%, respectively. The MMSE scale evaluates the selective deficits of one or more cognitive domains; the ACE-R scale is a wide-ranging study tool but it should be noted that the implementation of this scale requires time outlays.

Possibilities of antihypertensive therapy in correction of cognitive impairment in hypertensive patients

Data regarding possibilities of antihypertensive therapy to reduce a risk of the development of new cases of cognitive impairment are contradictory. So, the purpose of the study was to analyze the effect of antihypertensive therapy onto the dynamics of cognitive functions in hypertensive patients. We examined 90 patients with stage 1 and 2 hypertension, 2-3 degrees (middle age of patients was 49,66 ± 8,74 years). Clinical and anamnestic examination, laboratory and instrumental methods of examination were done to all patients. Neuropsychological tests, as GPCOG, MMSE, Schulte tables were used to study cognitive functions. Cognitive impairment were observed in 36 patients (40%). The combination of inhibitors of angiotensin-converting enzymes (іАCE) or angiotensin II receptor blockers (ARB) + calcium channel blocker (CCB) was used as antihypertensive therapy. While using this therapy not only the decrease and normalization of blood pressure but also improvement of cognitive functions were noticed. Particularly, in 61,29% cases patients gained obviously more points in the retesting MMSE(p=0,003) and GPCOG(p=0,01) and almost all patients (96,77%) needed less time to fulfill tasks by Schulte tables (p=0,0001). The total sum of points by MMSE scale increased by 3,66% (p=0,003), the total score by GPCOG scale increased by 22,24% (p=0,01), and in the control execution of Schulte test patients used less time by 14,39 % in comparison with initial results (p=0,0001).

Effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China.

Background:The incidence of hypertension in China is high, which seriously affects people's health, including occupational population in mining areas. Cognitive dysfunction has a serious impact on the work and life of patients. Lifestyle intervention can improve diabetes and cardiovascular diseases. However, there are few studies on the effects of lifestyle interventions on cognitive function in hypertensive patients. So the aim of this study was to analyze the effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China.Methods:In September 2013, a cluster sampling was conducted for the workers in the Shaanxi Jinduicheng (intervention group) and Hancheng (control group) mining areas. In both groups, according to the blood pressure (BP) level, they were divided into hypertension stage 1 to 3 subgroups; according to their age, they were divided into between 45 and 59 and under 45 years subgroups; and according to whether or not taking medicine, they were divided into Lifestyle intervention, Lifestyle intervention plus medication, Medication, and No lifestyle intervention nor medication subgroups. The intervention group received regular lifestyle intervention for 2 years, which included diet, smoke, drink, and exercise intervention. Mild cognitive impairment was measured by the Montreal Cognitive Assessment (MoCA). The arterial stiffness was measured by Omron Automatic Atherosclerosis Tester. We conducted BP measurement and MoCA questionnaire at baseline, 6, 12, and 24 months.Results:We analyzed a total of 510 mine workers, whose average age was 45.6 ± 13.4 years old. With the increase of BP level, the MoCA scores decreased significantly both in control and lifestyle intervention groups (P < .05). There was no obvious difference between the hypertensive patients whose age was between 45 and 59 to those under 45 in MoCA scores (P > .05). After 2 years, the BP, total cholesterol, glucose, and brachial-ankle pulse wave velocity of the Lifestyle intervention subgroup and Lifestyle intervention plus medication subgroup decreased (P < .05), and the MoCA scores and ankle-brachial index increased (P < .05), and the latter improved more significantly. Compared with the No lifestyle intervention nor medication subgroup, the BP and MoCA scores had no obvious changes at 6 months (P > .05), but the BP decreased and the MoCA scores increased significantly in the Lifestyle intervention and Lifestyle intervention plus medication subgroups after 1 and 2 years of lifestyle intervention (P < .05).Conclusion:Long-term lifestyle intervention can be used as adjunctive therapy to improve the BP and cognitive function of hypertensive occupational population in China.

Effects of a new nutraceutical combination on cognitive function in hypertensive patients

BackgroundChronic increased arterial blood pressure has been associated with executive dysfunction, slowing of attention and mental processing speed, and later with memory deficits. Due to the absence of a concrete therapeutic approach to this pathophysiological process, in the last decades there has been an increasing interest in the use of nutraceuticals, especially those with antioxidant properties, which own strong neuroprotective potential, that may help to improve cognitive function and to delay the onset of dementia.ResultsWe evaluated the effects of the treatment with a new nutraceutical preparation containing different molecules with potent antioxidant properties (AkP05, IzzeK®) and placebo on a cohort of thirty-six hypertensive patients. At baseline, neuropsychological evaluation, arterial stiffness and biochemical parameters of the subjects were comparable. After 6 months of treatment, there was a significant reduction of the augmentation index in the AkP05-treated group. Moreover, the measurement of cognitive function, evaluated with MoCA test and Word Match Testing, showed a significant improvement in patients receiving the active treatment. In addition, the group treated with nutraceutical reached a better Stroop test score, while subjects that received placebo did not showed any improvement. Finally, a positive relationship between SBP variation and the psychometric assessment with the EQ-VAS scale was observed only in the active treatment group.ConclusionsIn this study, we demonstrated that the therapy with a new nutraceutical preparation is able to significantly increase the scores of important neuropsychological tests in hypertensive patients already on satisfactory blood pressure control. Although future studies are needed to better characterize the molecular mechanisms involved, these results candidate the new nutraceutical combination as a possible therapeutic strategy to support the cerebrovascular functions and delay the onset of dementia in hypertensive patients.

GENETIC AND FUNCTIONAL FACTORS IN THE DEVELOPMENT OF COGNITIVE IMPAIRMENT IN HYPERTENSION: A PROSPECTIVE STUDY

Objective: to provide a dynamic assessment of cognitive functions in hypertensive patients in relation to the cerebral perfusion reserve and passive transmembrane ion transport velocity. Patients and methods. The investigation enrolled 79 hypertensive patients (the mean age at the start of examination was 54 years), including 44 women (mean age, 58±16.2 years) and 35 men (mean age, 60±9.8 years). During a screening, the mean duration of hypertension was more than 5 years in 60% of the patients and less than 5 years in 40%. 55% of the patients had adequate antihypertensive therapy and normal blood pressure (BP) (&lt;140/90 mm Hg), 45% were not on this therapy and they failed to achieve normal BP. The investigators evaluated a variety of factors, such as gender, age, BP, duration of hypertension, indicators of cerebrovascular reactivity (CVR), and levels of passive transmembrane ion transport, by using a model of Na+-Li+ countertransport (NLCT) in the erythrocyte membrane as an example. Results. Some risk factors were ascertained to influence cognitive functions in hypertension, but to a greater extent on CVR values in different vascular beds. A correlation was found between CVR and genetically determined NLCT velocity. Conclusion. The indicators CVR and NLCT may be used as predictors for the development and progression of vascular cognitive impairment.

Comparison of efficacy of telmisartan with losartan in patients of essential hypertension with cognitive impairment

Background: Hypertension can lead to mild to moderate alteration in the brain structure and function including cognitive functions impairments. Many first line antihypertensive drugs are devoid of producing significant improvement in cognitive functions; in fact some of them worsen cognitive function. Data suggests that angiotensin II receptor antagonist slows the progression of cognitive impairment associated with hypertension. Hence present study was planned to compare the efficacy of telmisartan with losartan in hypertensive patients with cognitive impairment. Methods: Prospective, randomized, single blind, comparative study was conducted for period of 24 weeks. Study population was enrolled into two groups: group A (losartan 50 mg) and group B (telmisartan 20 mg). Cognitive functions were assessed by mini mental status examination and trail making test part-A. Qualitative data were analysed by using “Fischer’s test” and quantitative data was analysed by using “t test”. Results: Baseline clinical characteristics of patients receiving losartan and telmisartan did not show significant difference Telmisartan was as effective as losartan in lowering systolic and diastolic blood pressure in patients of essential hypertension. Increase in mini mental status examination score appeared similar in both groups and there was no statistically significant difference (p&gt;0.05) between the two groups at 12 and 24 weeks of therapy. Reduction in trail making test part A score was slightly more among patient receiving losartan but on comparison of two groups reduction in trail making test part A score was not statistically significant (p&gt;0.05) at 12 and 24 weeks of therapy. Conclusions: Telmisartan is as effective as losartan in controlling blood pressure and improving cognitive function in hypertensive patients with cognitive impairment.

Cross Section Case Control Study for Clinical Correlates of Cognitive Impairment in Patients with Midlife Early Hypertension: Differential Effect of Antihypertensives

Abstract High blood pressure (BP) is considered a risk factor for cerebrovascular disease, including stroke. Little is known about the importance of BP on the progression of microvascular disease of the brain, and cognitive impairment. In this study 85 patients (45 women and 40 men; age range 40–55) were assessed for blood pressure with the mean value of the 2 measurements of 2 visits that were calculated and analysed. Cognitive testing was performed using a combination of 4 well-validated standardized tests: the Mini Mental State Examination, Trail Making Test (TMT) A, (TMT) B, and a verbal fluency test. The control group of 60 normal volunteers matched for age, sex and education without changes in blood pressure were compared for cognitive changes. Result show significant difference between patients and controls in cognitive tests (p=0.000) and positive correlation between hypertension and cognitive impairment, that was more associated with elevated systolic blood pressure, older age, male sex and early onset hypertension. Positive correlation was also found with improved cognitive functions in hypertensive patients using diuretics, angiotensin II inhibitors and antihypertensive combination. The results indicate that midlife early high BP levels increase the risk for cognitive impairment and dementia. This association may be modified by antihypertensive medication.

Effect of antihypertensive therapy on cognitive function in hypertensive patients with obesity

Objective. To assess and compare efficacy of perindopril, eprosartan and amlodipine according to their effects on cognitive function in patients with arterial hypertension and obesity. Design and methods. This open clinical trial included 78 patients (mean age — 46,8 ± 5,5 years), 26 of them received perindopril, 26 — eprosartan, and 26 — amlodipine. Monotherapy has lasted for 12 months. At baseline and 12 months later, all participants underwent 24-hour blood pressure monitoring, neuropsychological testing and cognitive evoked potential (P300) to assess cognitive function. Results. Twelve-month monotherapy with eprosartan and amlodipine significantly improved cognitive function (neuropsychological testing and P300) in patients with obesity and arterial hypertension.

Role of central angiotensin receptors in scopolamine-induced impairment in memory, cerebral blood flow, and cholinergic function

Inhibition of renin-angiotensin system (RAS) improves cognitive functions in hypertensive patients. However, role of AT1 and AT2 receptors in memory impairment due to cholinergic hypofunction is unexplored. This study investigated the role of AT1 and AT2 receptors in cerebral blood flow (CBF), cholinergic neurotransmission, and cerebral energy metabolism in scopolamine-induced amnesic mice. Scopolamine was given to male Swiss albino mice to induce memory impairment tested in passive avoidance and Morris water maze tests after a week long administration of blocker of AT1 receptor, candesartan, and AT2 receptor, PD123, 319. CBF was measured by laser Doppler flowmetry. Biochemical and molecular studies were done in cortex and hippocampus of mice brain. Scopolamine caused memory impairment, reduced CBF, acetylcholine (ACh) level, elevated acetylcholinesterase (AChE) activity, and malondialdehyde (MDA). Administration of vehicle had no significant effect on any parameter in comparison to control. Candesartan prevented scopolamine-induced amnesia, restored CBF and ACh level, and decreased AChE activity and MDA level. In contrast, PD123, 319 was not effective. However, the effect of AT1 receptor blocker on memory, CBF, ACh level, and oxidative stress was blunted by concomitant blockade of AT2 receptor. Angiotensin-converting enzyme (ACE) activity, ATP level, and mRNA expression of AT1, AT2, and ACE remained unaltered. The study suggests that activation of AT1 receptors appears to be involved in the scopolamine-induced amnesia and that AT2 receptors contribute to the beneficial effects of candesartan. Theses finding corroborated the number of clinical studies that RAS inhibition in hypertensive patients could be neuroprotective.

EFFECT OF METOPROLOL ON COGNITIVE FUNCTION IN HYPERTENSIVE PATIENTS OF YOUNG TO MIDDLE AGE

Aim. To evaluate the effect of metoprolol tartrate on blood pressure (BP) and cognitive function in young to middle aged patients with essential hypertension (HT). Material and methods. 40 men (age of 49,0±1,9 y.o.) with HT of I-II stage not taking antihypertensive medication regularly were enrolled into the study. All patients were given metoprolol tartrate (start dose 50-100 mg/d). Variables of 24-h BP monitoring and clinic BP, left ventricular mass index (measured by echocardiography) and characteristics of cognitive function (memory, attention, thinking and neurodynamic) were assessed at the start, after 1 and 6 months of therapy. Results. Good and satisfactory antihypertensive effect was achieved in 75% of hypertensive patients with metoprolol (186,6±13,4mg/d) monotherapy. Metoprolol significantly decreased maximum day-time systolic and diastolic BP, maximum night-time diastolic BP, mean day-time systolic and night-time diastolic BP, time-index, load-index and variability-index for night-time diastolic BP, day-time and night-time pulse BP. Left ventricular mass index reduced significantly (p&lt;0,0001). After 6 months of therapy significant improvement of memory, attention, thinking and neurodynamic was observed Conclusion. Metoprolol had beneficial effect on cognitive function in hypertensive patients, which demonstrate its cerebroprotective properties in addition to antihypertensive action. Metoprolol can reduce the risk of dementia in young to middle aged patients with HT.