The online version of this article (doi:10.1186/1476-7120-10-41) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
EMD: participated in the study design, clinical assessment of participants, ultrasound examinations, participated in the discussion of the results and helped to write the manuscript. LTG Jr: participated of the clinical assessment of participants, measurement of the central blood pressure and in the discussion of the results.DDM: participated in the collection of clinical data, the blinded measurement of the ultrasound examinations and helped to draft the manuscript. CM: participated in data collection, assessments of peripheral blood pressure and the central blood pressure examination and elaborated the figures. HM Jr: participated of the study design, assessment of the methodology, blinded evaluation of ultrasound examinations and helped with the final discussion. JFVM: participated in the clinical assessment of patients and participated in the discussion of the results. JCYT: participated of the study design, methodological assessment, statistical review, discussion of the results and helped to write the manuscript, corrected the final version in English and submitted the article. All authors read and approved the final manuscript.
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.
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.
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).
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.
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- Carotid intima-media thickness is associated with cognitive deficiency in hypertensive patients with elevated central systolic blood pressure
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Luiz Tadeu Giollo Jr
Débora Dada Martinelli
Heitor Moreno Júnior
José Fernando Vilela-Martin
Juan Carlos Yugar-Toledo
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