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Cardiovascular remodeling in patients with hypertension with different degrees of cognitive impairment

Natalia Y Osovska¹, Yulia V Mazur¹, Olga M Bereziuk¹

¹National Pirogov Memorial Medical University, Vinnytsya, Ukraine.

Wiadomosci Lekarskie (Warsaw, Poland : 1960)

|May 6, 2019

Insights

Hypertension contributes to cognitive decline through cardiovascular changes. Increased blood pressure and heart remodeling correlate with cognitive impairment, aiding early diagnosis and treatment.

Area of Science:

Cardiology
Neurology
Vascular Medicine

Background:

Vascular cognitive impairment (VCI) encompasses cognitive decline from cerebrovascular insufficiency.
VCI extends beyond traditional concepts of vascular cognitive disturbances.

Purpose of the Study:

To correlate cardiovascular structural and functional changes with cognitive function in hypertensive patients.
To investigate the relationship between hypertension, cardiovascular remodeling, and cognitive impairment.

Main Methods:

A comprehensive survey of 146 patients with stage II/III hypertension.
Patients with mild and moderate cognitive impairment (CI) were assessed using neuropsychological testing.
Patients were categorized into three groups based on cognitive status for comparative analysis.

Main Results:

Increased cardiovascular remodeling signs correlated with more pronounced cognitive decline.
Hypertensive patients with CI exhibited more pathological hemodynamic changes, including higher heart rates and impaired LV diastolic function.
Higher average daily blood pressure (BP) and increased BP variability were observed with worsening cognitive impairment.

Conclusions:

A clear correlation exists between cognitive impairment severity and daily BP profile changes, particularly average daily systolic BP and BP variability.
Cardiovascular structural changes (ventricle and vessel geometry) can help predict cognitive impairment.
This research supports timely diagnosis and adequate therapy for VCI in hypertensive patients.

Read full analysis

Abstract

Objective:

Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension.

Patients And Methods:

Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data.

Results:

Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree.

Conclusion:

Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.

Keywords:

antihypertensive therapy cardiovascular remodeling cognitive impairment

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