Impaired cognitive executive dysfunction in adult treated hypertensives with a confirmed diagnosis of poorly controlled blood pressure

Abstract

Background: High blood pressure (BP) poses a major risk for cognitive decline. Aim of the study was to highlight the relationship between cognitive assessment scores and an effective therapeutic BP control.

Methods: By medical visit and ambulatory BP monitoring (ABPM), we studied 302 treated hypertensives, subdivided according to office/daytime BP values into 120 with good (GC) and 98 poor (PC) BP control, 40 with "white coat hypertension" (WCH) and 44 a "masked-hypertension" phenomenon (MH). Patients underwent neuropsychological assessment to evaluate global cognitive scores at the Mini Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) and attention/executive functions (Delayed Recall, Digit Span Forwards, Digit Span Backwards, Selective Attention, Verbal Fluency, Stroop Test and Clock Drawing). Carotid intima-media thickness (IMT) served as the index of vascular damage.

Results: There were no differences among the groups in terms of gender, age, education, metabolic assessment, clinical history and hypertension treatment. GC presented lower office and ambulatory BP values and IMT. PC performed worse than GC on global executive and attention functions, especially executive functions. In PC, office systolic BP (SBP) was significantly associated to the MMSE and FAB scores and, in particular, to Verbal Fluency, Stroop Errors and Clock Drawing tests. Office diastolic BP (DBP) was associated to Selective attention, nocturnal SBP to Digit Span backwards and Verbal Fluency. Worse cognitive assessment scores were obtained in WCH than GC.

Conclusions: The findings showed that in adult treated hypertensives, a poor BP control, as both doctor's office and daytime scores, is associated to impaired global cognitive and especially executive/attention functions.

Keywords: ambulatory blood pressure monitoring.; blood pressure control; cognitive dysfunction; executive impairment.

Figure 1

Ambulatory blood pressure monitoring characteristics. GC: treated hypertensives with a confirmed satisfactorily controlled blood pressure both in the office and during awake hours; PC: treated hypertensives with a confirmed insufficiently controlled blood pressure both in the office and during awake hours; WCH: treated hypertensives with an inconsistent hypertension state (“isolated clinic hypertension/white-coat hypertension” effect with BP>140/90 mmHg in the office but diurnal BP<135/85 mmHg during awake hours; MH: treated hypertensives with an inconsistent hypertension state (“masked hypertension” effect) with BP<140/90 mmHg in the office but diurnal BP>135/85 mmHg awake hours; SBP: systolic blood pressure; DBP: diastolic blood pressure; day: awake hours: night: sleeping hours (***: p<0.001 vs GC; °°°:p<0.001 vs PC).

Figure 2

Neuropsychological assessment in treated hypertensives with a confirmed BP state. GC: treated hypertensives with a confirmed satisfactorily controlled blood pressure both in the office and during awake hours; PC: treated hypertensives with a confirmed insufficiently controlled blood pressure both in the office and during awake hours (*: p<0.05 , **: p<0.01 vs WCH).