What is the clinical evidence from this study?

Study design: Case-Control. Population: Midlife early hypertension (n=145). Intervention: Midlife early hypertension vs. Normotensive controls. Primary outcome: Mini Mental State Examination (MMSE) score (p=0.0008).

What does this research mean for the field?

Midlife early hypertension is significantly associated with cognitive impairment, though this risk may be modified by the use of specific antihypertensive medications such as diuretics and angiotensin II inhibitors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 1, 2015Open Access

Cross Section Case Control Study for Clinical Correlates of Cognitive Impairment in Patients with Midlife Early Hypertension: Differential Effect of Antihypertensives

Key Result

Midlife early hypertension was significantly associated with cognitive impairment, evidenced by lower Mini Mental State Examination scores in hypertensive patients compared to normotensive controls (19.8 vs 24.8, p=0.0008).

Study Design

Type

Case-Control (n=145)

Multicenter

Yes

Structured PICO

Does midlife early hypertension correlate with cognitive impairment compared to normotensive controls, and is this modified by antihypertensive therapy?

Population

145 individuals, comprising 85 patients with midlife early hypertension (45 women, 40 men; age range 40-55) and 60 normal volunteers matched for age, sex, and education without changes in blood pressure.

Intervention

Midlife early hypertension (with subgroup analysis of antihypertensive use including diuretics, angiotensin II inhibitors, and combinations)

Comparator

Normotensive controls (60 normal volunteers matched for age, sex, and education)

Outcome

Cognitive impairment assessed by a combination of 4 standardized tests: Mini Mental State Examination, Trail Making Test (TMT) A, TMT B, and verbal fluency testsurrogate

Midlife early hypertension is significantly associated with cognitive impairment, an effect that may be mitigated by the use of antihypertensive medications such as diuretics and angiotensin II inhibitors.

Main Result

Absolute Event Rate: 19.8% vs 24.8%

p-value: p=0.0008

Limitations

Convenient sample
Cross-sectional design limits causal inference
Small sample size
Lack of functional imaging techniques
Did not examine correlations with smoking, abnormal lipid profile, or hyperinsulinemia

Abstract

Abstract High blood pressure (BP) is considered a risk factor for cerebrovascular disease, including stroke. Little is known about the importance of BP on the progression of microvascular disease of the brain, and cognitive impairment. In this study 85 patients (45 women and 40 men; age range 40–55) were assessed for blood pressure with the mean value of the 2 measurements of 2 visits that were calculated and analysed. Cognitive testing was performed using a combination of 4 well-validated standardized tests: the Mini Mental State Examination, Trail Making Test (TMT) A, (TMT) B, and a verbal fluency test. The control group of 60 normal volunteers matched for age, sex and education without changes in blood pressure were compared for cognitive changes. Result show significant difference between patients and controls in cognitive tests (p=0.000) and positive correlation between hypertension and cognitive impairment, that was more associated with elevated systolic blood pressure, older age, male sex and early onset hypertension. Positive correlation was also found with improved cognitive functions in hypertensive patients using diuretics, angiotensin II inhibitors and antihypertensive combination. The results indicate that midlife early high BP levels increase the risk for cognitive impairment and dementia. This association may be modified by antihypertensive medication.

KI fragen

Bookmark

View Full Paper