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Carotid intima-media thickness is associated with cognitive deficiency in hypertensive patients with elevated central systolic blood pressure

Eros da Mota Dias1, Luiz Tadeu Giollo1, Débora Dada Martinelli1, Camila Mazeti1, Heitor Moreno Júnior2, José Fernando Vilela-Martin1 and Juan Carlos Yugar-Toledo1*

Author Affiliations

1 Hypertension Clinic, Department of Internal Medicine, State Medical School of São José do Rio Preto (FAMERP), Rua: Las Vegas 200, São José do Rio Preto, SP CEP 15093-010, Brazil

2 Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP CEP 13414-093, Brazil

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Cardiovascular Ultrasound 2012, 10:41  doi:10.1186/1476-7120-10-41

Published: 18 October 2012

Abstract

Background

The 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.

Methods

Two 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.

Results

There 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).

Conclusions

Hypertensive 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.

Keywords:
Hypertension; Cognitive impairment; Intima-media thickness; Central systolic blood pressure