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. 2011 Mar 1;123(8):858-65.
doi: 10.1161/CIRCULATIONAHA.110.978114. Epub 2011 Feb 14.

Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study

Ihab Hajjar  1 , Lien Quach, Frances Yang, Paulo H M Chaves, Anne B Newman, Kenneth Mukamal, Will Longstreth Jr, Marco Inzitari, Lewis A Lipsitz
Affiliations

Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study

Ihab Hajjar et al. Circulation. .

Abstract

Background: Our objective was to investigate the association between hypertension and concurrent impairments in mobility, cognition, and mood; the role of brain white matter hyperintensities in mediating this association; and the impact of these impairments on disability and mortality in elderly hypertensive individuals.

Methods and results: -Blood pressure, gait speed, digit symbol substitution test, and the Center for Epidemiological Studies Depression Scale were measured yearly (1992-1999) on 4700 participants in the Cardiovascular Health Study (age: 74.7, 58% women, 17% blacks, 68% hypertension, 3600 had brain magnetic resonance imaging in 1992-1993, survival data 1992-2005). Using latent profile analysis at baseline, we found that 498 (11%) subjects had concurrent impairments and 3086 (66%) were intact on all 3 measures. Between 1992 and 1999, 651 (21%) became impaired in all 3 domains. Hypertensive individuals were more likely to be impaired at baseline (odds ratio 1.23, 95% confidence interval 1.04 to 1.42, P=0.01) and become impaired during the follow-up (hazard ratio=1.3, 95% confidence interval 1.02 to 1.66, P=0.037). A greater degree of white matter hyperintensities was associated with impairments in the 3 domains (P=0.007) and mediated the association with hypertension (P=0.19 for hypertension after adjusting for white matter hyperintensities in the model, 21% hazard ratio change). Impairments in the 3 domains increased subsequent disability with hypertension (P<0.0001). Hypertension mortality also was increased in those impaired (compared with unimpaired hypertensive individuals: HR=1.10, 95% confidence interval 1.04 to 1.17, P=0.004).

Conclusions: Hypertension increases the risk of concurrent impairments in mobility, cognition, and mood, which increases disability and mortality. This association is mediated in part by microvascular brain injury.

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Conflict of interest statement

Conflict of Interest Disclosures: None.

Figures

Figure 1
Figure 1
Baseline and follow-up classification of the Cardiovascular Health Study population into the control, impaired, and remainder groups.
Figure 2
Figure 2
Kaplan-Meier survival curves for the impaired and control hypertensive and normotensive groups in the Cardiovascular Health Study. Footnote: NTN: Normotension; HTN: hypertension. Adjusted for age, gender, race, body mass index, stroke, smoking history, coronary heart disease, and congestive heart failure
See this image and copyright information in PMC

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