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Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study
Ryo Mizuhara1,2, Shingo Mitaki3, Masahiro Takamura3
1Department of Neurology, National Hospital Organization Maizuru Medical Center, 2410 Yukinaga, Maizuru, Kyoto, 625-8502, Japan. izu04ryou@gmail.com.
Insights
High pulse pressure is linked to poorer cognitive function in Japanese adults without dementia. This association was observed independently of systolic blood pressure, suggesting pulse pressure is a key factor in cognitive health.
Area of Science:
- Neurology
- Cardiology
- Gerontology
Background:
- Vascular risk factors, particularly hypertension, are increasingly linked to cardiovascular disease and cognitive impairment.
- The specific impact of pulse pressure on cognitive function remains a subject of ongoing research and debate.
- Understanding this relationship is crucial for developing targeted interventions for cognitive decline.
Purpose of the Study:
- To investigate the association between pulse pressure and cognitive function in a Japanese cohort.
- To determine if systolic blood pressure mediates the relationship between pulse pressure and cognitive performance.
- To explore the link between pulse pressure and subclinical brain changes like silent brain lesions.
Main Methods:
- A cohort of 2,546 Japanese individuals undergoing health examinations was analyzed.
- Participants were categorized into high and low pulse pressure groups (cut-off 65 mmHg) and propensity matched.
- Cognitive functions (Okabe's test, Kohs' test) and brain MRI were assessed, with mediation analysis for blood pressure.
Main Results:
- Higher pulse pressure was significantly associated with lower scores on Okabe's and Kohs' tests.
- Systolic blood pressure did not significantly mediate the relationship between pulse pressure and cognitive impairment.
- No significant association was found between pulse pressure and silent brain lesions.
Conclusions:
- Elevated pulse pressure is associated with reduced cognitive performance in Japanese individuals without dementia.
- This association is independent of systolic blood pressure, highlighting pulse pressure as a distinct risk factor.
- Further research may elucidate the mechanisms underlying pulse pressure's impact on cognitive function.
Background:
Growing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the impact of pulse pressure on cognitive function remains controversial. In this study, we evaluated the associations between pulse pressure and cognitive function in a Japanese health examination cohort using propensity matching analysis.
Methods:
We examined 2,546 individuals with a mean age of 60.8 ± 10.3 years who voluntarily participated in health examination. Clinical variables included pulse pressure, and brain magnetic resonance imaging (MRI). We divided the participants into the high and low pulse pressure groups with a pre-defined cut-off value of 65 mmHg and evaluated their physical examination data, cognitive functions including Okabe's test, Kohs' test, and silent brain lesions using propensity matching. To clarify whether pulse pressure and blood pressure have different implications for cognitive function, a mediating analysis was also conducted.
Results:
From the 2,546 subjects, 439 (17.2%) were in the high PP group. The propensity matching algorithm produced 433 pairs of patients with similar propensities. Higher pulse pressure corresponded to lower Okabe and Kohs' scores (44.3 ± 7.1 vs 42.7 ± 7.5; p = 0.002, 97.9 ± 18.0 vs 95.0 ± 18.1 p = 0.019, respectively). The relationship between pulse pressure and cognitive impairment was not significantly mediated by systolic blood pressure. We observed no significant associations between silent brain lesions and pulse pressure.
Conclusion:
High pulse pressure was associated with lower cognitive performance without systolic blood pressure mediation in Japanese subjects without dementia.
Related Concept Videos
01:24Blood Pressure
01:17Measurement of Blood Pressure
01:21Sites for measruring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.