SUMMARY Fifty-four subjects with uncomplicated essential hypertension and 54 normotensive subjects were compared with regard to a widely employed clinical index of cognitive dysfunction (the Average Impairment Rating) calculated from neuropsychologkal tests that discriminate between brain-damaged and neurologically normal persons. Hypertensive subjects exhibited lower mean scores on this index when education was ignored, but results were not the same for highly educated and less well educated groups. There were no differences between exceptionally well educated hypertensive and normotensive subjects, but in the less well educated group, hypertensive subjects performed more poorly than normotensive subjects. The percentages of hypertensive and normotensive subjects scoring in a cognitively impaired range on the Average Impairment Rating were low and did not differ for either education group. These data 1) indicate the important role of subtle differences in education level with respect to positive or negative findings for studies comparing hypertensive and normotensive subjects and 2) illustrate the important role of clinical neuropsychological indices of cognitive dysfunction when one wishes to make meaningful inferences regarding cerebral cortical function in hypertensive subjects. (Hypertension 9: 192-197, 1987)
KEY WORDS • hypertensionAverage Impairment Rating neuropsychology • education * cognitive function K VIEWS of the literature indicate lower levels of cognitive, perceptual, and psychomotor performance for hypertensive than for normotensive groups.1 " 3 This has been true for subjects defined as mildly hypertensive 4 or as uncomplicated, essential hypertensive 5 " 7 and has been observed for tests that can be particularly sensitive to brain impairment when proper controls and testing procedures are employed (i.e., clinical neuropsychological tests).