Yuichiro Yano1, George L Bakris, Takashi Inokuchi, Yusuke Ohba, Noboru Tamaki, Masahiko Nagata, Masachika Kuwabara, Naoto Yokota, Takuma Eto, Munetoshi Kuroki, Kazuyuki Shimada, Kazuomi Kario. 1. aAmerican Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA bDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi cDepartment of Orthopedics, Chikamorikai Medical Group, Kochi dTamaki Clinic eKijo Clinic fKuwabara Clinic gYokota Naika hEto Cardiology Clinic iKuroki Naika, Miyazaki, Japan.
Abstract
OBJECTIVES: This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients. METHODS: We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points). RESULTS: CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction. CONCLUSION: Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.
OBJECTIVES: This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensivepatients. METHODS: We recruited 585 hypertensivepatients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points). RESULTS: CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction. CONCLUSION:Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensivepatients.
Authors: Susan S Xie; Carly M Goldstein; Emily C Gathright; John Gunstad; Mary A Dolansky; Joseph Redle; Joel W Hughes Journal: Heart Lung Date: 2015 Sep-Oct Impact factor: 2.210
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