Arterial Stiffness, Cognitive Dysfunction and Adherence to Antihypertensive Agents. Is there a Link to Hypertensive Patients?

Abstract

: The incidence of hypertension (HTN) and its cardiovascular (CV) complications are increasing throughout the world. Blood pressure (BP) control remains unsatisfactory worldwide. Medical inertia and poor adherence to treatment are among the factors that can partially explain, why BP control rate remains low. The introduction of a method for measuring the degree of adherence to a given medication is now a prerequisite. Complex treatment regimes, inadequate tolerance and frequent replacements of pharmaceutical formulations are the most common causes of poor adherence. In contrast, the use of stable combinations of antihypertensive drugs leads to improved patient adherence. : We aim to review the relationships between arterial stiffness, cognitive function and adherence to medication in patients with HTN. : Large artery stiffening can lead to HTN. In turn, arterial stiffness induced by HTN is associated with an increased CV and stroke risk. In addition, HTN can induce disorders of brain microcirculation resulting in cognitive dysfunction. Interestingly, memory cognitive dysfunction leads to a reduced adherence to drug treatment. Compliance with antihypertensive treatment improves BP control and arterial stiffness indices. Early treatment of arterial stiffness is strongly recommended for enhanced cognitive function and increased adherence.

Association of brachial-ankle pulse wave velocity with cognitive impairment in peritoneal dialysis patients

“…Arterial stiffness has been appeared in the early stages of chronic kidney disease (CKD), and might be increased in ESRD patients due to deterioration of renal function, the deposit of abnormal product derived from proteins or lipids, the reduction of advanced glycation end products (AGEs), alteration of calcium and phosphate metabolism, low serum albumin levels, and high C-reactive protein serum levels [14,15]. As one of exact vascular risk factors, arterial stiffness has been demonstrated to be associated with CI in elderly population [16,17] and patients with chronic diseases such as hypertension [18][19][20] and diabetes mellitus [21,22]. However, there is a lack of related studies focuses on PD patients.…”

Impact of Stiffer Arteries on the Response to Antihypertensive Treatment: A Longitudinal Study of the SardiNIA Cohort

“…With advancing age, the issue of adherence to antihypertensive therapy is further complicated by the greater occurrence of cognitive impairment. 33 The major strength of this study is the long follow-up time and the availability of repeated measures at regular intervals, allowing assessment of structural rather than functional arterial changes that likely underline changes in PWV. A further strength is the classification of groups according to treatment and BP levels at each visit.…”

Assessing a Pharmacist-Enabled Intervention to Improve Adherence to Medication for Hypertension, Dyslipidemia, and Chronic Venous Circulation Disorders in Greece

“…The former are forgetfulness, 9 denial, 4 lack of motivation, cultural issues, low educational level or health literacy, 10 alternate belief systems, and lack of proper physician-patient communication. 11,12 The latter 13 refer to limited treatment outcomes, failure to improve or maintain a patient's health status, patient's access to medications, 9 complexity, [14][15][16][17][18] cost and time of treatment, and side effects. 6,19 To address this persistent challenge of nonadherence, the literature reports on several pharmacist-led interventions that have shown a positive impact on patients' adherence to medication and clinical outcomes.…”