Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance

Abstract

ABSTRACT.Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall.Objective:To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension.Methods:211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography.Results:Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests.Conclusion:Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.

Diabetes, but Not Hypertension and Obesity, Is Associated with Postoperative Cognitive Dysfunction

“…The null finding suggests that vascular damage as a consequence of hypertension may only play a minor role in POCD development and replicates results of our meta-analysis of hypertension as a candidate risk factor for POCD [10]. Though we did not assess severity of hypertension which may be important in cognitive risk prediction [48], our finding warrants further enquiry particularly in view of established associations of this risk factor with cognitive impairment per se [15, 49, 50]. A beneficial effect of anti-hypertensive treatment on cognitive risk as an explanation of the null finding appears unlikely as the balance of evidence from RCTs speaks against such effects [51, 52].…”

Memory impairment in spontaneously hypertensive rats is associated with hippocampal hypoperfusion and hippocampal vascular dysfunction

“…62 – 64 Muela et al. 62 reported that patients with severe hypertension had increased aortic PWV that was associated with decreased cerebral vasoreactivity to hypercapnia and impaired memory function. However, assessment of cerebrovascular reactivity was completed using laser Doppler of middle cerebral arteries.…”

“…Clinical studies suggest that aortic stiffening directly influences cognition, including hippocampal-dependent memory function via cerebrovascular dysfunction. [62][63][64] Muela et al 62 reported that patients with severe hypertension had increased aortic PWV that was associated with decreased cerebral vasoreactivity to hypercapnia and impaired memory function. However, assessment of cerebrovascular reactivity was completed using laser Doppler of middle cerebral arteries.…”

Multicentric evidence of emotional impairments in hypertensive heart disease

“…In addition, most previous works have failed to include assessments of general cognitive functions 6 – 8 , 14 , 15 . This is a major caveat, too, since emotional processes are closely related to executive functions, memory, language, and otherwise general cognitive domains 16 – 22 , which, in turn, are typically affected in subjects with high blood pressure 23 – 28 . Without such data, the literature is moot on whether emotional disturbances in essential hypertension constitute primary deficits or secondary disruptions following from other general alterations triggered by high blood pressure.…”

“…Against this background, we performed the first multi-center study assessing emotional recognition in HHD patients diagnosed by specialized cardiologists in clinics from two countries. First, to control for possible cognitive differences between patients and controls 23 – 28 , and to account for the well-established role of language skills in emotion processing 21 , 22 , we administered an executive function battery and a highly sensitive cognitive screening tool including language measures (see details in “ Cognitive assessment ”, Table 1 ). Then, participants performed a validated emotion morphing task 29 .…”