Hypertension: Cognitive and behavioral considerations

King, H. E.; Miller, Robert E.

doi:10.1007/bf01108858

Cited by 22 publications

(15 citation statements)

References 101 publications

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“…Our attention factor was unrelated to SBP. This accords with work in this area; decrements typically relate to hypertension, but different studies find decrements in different cognitive processes . Tzourio et al attributed such variability to age, duration and intensity of heightened BP, influence of BP‐related variables (eg, arterial stiffness), and impact on differing cerebrovascular structures.…”

Section: Discussionsupporting

confidence: 68%

Prehypertensive Blood Pressures and Regional Cerebral Blood Flow Independently Relate to Cognitive Performance in Midlife

Jennings

Muldoon

Ryan

et al. 2017

JAHA

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BackgroundHigh blood pressure is thought to contribute to dementia in late life, but our understanding of the relationship between individual differences in blood pressure (BP) and cognitive functioning is incomplete. In this study, cognitive performance in nonhypertensive midlife adults was examined as a function of resting BP and regional cerebral blood flow (rCBF) responses during cognitive testing. We hypothesized that BP would be negatively related to cognitive performance and that cognitive performance would also be related to rCBF responses within areas related to BP control. We explored whether deficits related to systolic BP might be explained by rCBF responses to mental challenge.Methods and ResultsHealthy midlife participants (n=227) received neuropsychological testing and performed cognitive tasks in a magnetic resonance imaging scanner. A pseudocontinuous arterial spin labeling sequence assessed rCBF in brain areas related to BP in prior studies. Systolic BP was negatively related to 4 of 5 neuropsychological factors (standardized β>0.13): memory, working memory, executive function, and mental efficiency. The rCBF in 2 brain regions of interest was similarly related to memory, executive function, and working memory (standardized β>0.17); however, rCBF responses did not explain the relationship between resting systolic BP and cognitive performance.ConclusionsRelationships at midlife between prehypertensive levels of systolic BP and both cognitive and brain function were modest but suggested the possible value of midlife intervention.

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Section: Discussionsupporting

confidence: 68%

Prehypertensive Blood Pressures and Regional Cerebral Blood Flow Independently Relate to Cognitive Performance in Midlife

Jennings

Muldoon

Ryan

et al. 2017

JAHA

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“…The cognitive deficits associated with common conditions and illnesses such as alcoholism (Carlin, 1991;Goldman, 1983;Grant, 1987), chronic obstructive pulmonary disease (Berry, Webb, Block, Bauer, & Switzer, 1986;Grant, Heaton, McSweeny, Adams, & Timms, 1982), hypertension (King & Miller, 1990;Waldstein, Manuck, Ryan, & Muldoon, 1991), migraine (Hooker & Raskin, 1986;Zeitlin & Oddy, 1984) and diabetes (Desmond, Tatemichi, Paik, & Stern, 1993;Ryan, 1988;Ryan & Williams, 1993), to name just a few, cannot easily be distinguished from those of mild traumatic brain injury.…”

Section: Medical and Psychiatric Illnessmentioning

confidence: 97%

A review of mild head trauma. part II: Clinical implications

Binder

1997

Journal of Clinical and Experimental Neuropsychology

225

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In Binder et al. (1997) a metal-analytic review revealed a small effect size attributable to a history of mild head trauma (MHT). The results suggested a weak association between MHT and persistent neuropsychological deficits. In this paper, additional outcome data are summarized and the results are discussed. On a chronic basis, 7-8% of MHT patients remain symptomatic and 14% are disabled from work. Magnetic resonance studies of acutely injured persons may show lesions that are not detected in usual clinical practice. It is likely that the effects of these lesions dissipate with time, consistent with the neuropsychological data. The association between MHT and cognitive deficits, symptoms, and disability may not be casual; data suggest that MHT patients have more psychosocial problems prior to injury than do non-injured persons. The examiner of the MHT patient with chronic complaints must consider alternative medical and psychiatric explanations and perform a differential diagnosis. The possibility of a neurological basis for sustained neuropsychological problems cannot be completely dismissed. Presently, however, there is little evidence for neurological causation of most persisting complaints.

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“…Although not precisely a complex cognitive task, time estimation was included because of reports in the literature stating that individuals with hypertension may develop an altered time sense. 9 Memory was evaluated with a three-word, short-term memory task with rehearsal prevention, portions of the Benton Visual Retention test, and a subset of the Wechsler Memory Scale (WMS), including the Logical Memory, Digit Span, and Paired Associate Learning portions of this scale with immediate and delayed recall of the Logical Memory subtest. Language was assessed with a controlled word production (verbal fluency) test and the Token test.…”

Section: Behavioral Assessmentmentioning

confidence: 99%

“…11 For example, time estimation was studied because untreated hypertensive subjects were found to have poorer time judgment than normotensive subjects but improved with treatment. 9 The ADL questionnaire covered the broad areas of personal hygiene and other instrumental self-care activities, household and social activities, and ambulation. Patients were also asked specifically about drowsiness and sexual problems.…”

Section: Behavioral Assessmentmentioning

confidence: 99%

Treatment of hypertension in the elderly: II. Cognitive and behavioral function. Results of a Department of Veterans Affairs Cooperative Study.

et al. 1990

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This study was designed to determine whether blood pressure reduction, per se, causes adverse effects on cognitive and behavioral function in elderly hypertensive patients. Men with mild-to-moderate diastolic hypertension who had passed their 60th birthday were entered into the trial. After a placebo washout period, they were assigned in a randomized, double-blind manner to one of two groups receiving hydrochlorothiazide (either 25 mg once or twice daily or 50 mg once or twice daily). Responders entered a 1-year maintenance period. Nonresponders were randomly assigned to double-blind treatment with hydralazine, methyldopa, metoprolol, or reserpine added to the diuretic therapy. During the placebo and treatment periods, patients underwent a battery of psychometric tests designed to assess cognitive function, motor skills, memory, and affect. A separate questionnaire assessed the patient's ability to perform activities of daily living. A subset of patients blindly being treated with placebo received the same battery of tests as a control for practice effect. The results showed that there was similar improvement on the psychometric tests between those patients whose blood pressure was successfully reduced and the placebo-treated control group. Therefore, the practice effect did not obscure a true deterioration in function. There were no substantive differences between the lower and higher doses of diuretic or among the four drugs added to the diuretic, although there were qualitative differences in side effects. We conclude that blood pressure reduction, per se, does not adversely affect cognitive and behavioral function in elderly hypertensive patients and that antihypertensive treatment is safe and effective in these patients. (Hypertension 1990;15:361-369) E levated blood pressure in elderly patients can be safely and effectively reduced by using either hydrochlorothiazide (HCTZ) alone or, if necessary, by the addition of hydralazine, methyldopa, metoprolol, or reserpine to HCTZ.1 This paper addresses the perception that such blood pressure reduction in elderly patients may be associated with uncomfortable or even disabling side effects. by drug therapy. As part of the study detailed in part I, 1 we performed extensive psychometric testing to determine objectively the effect of treatment on cognitive function, motor skills, and memory. In addition, we assessed changes in affective state and activities of daily living. MethodsThe details of the design for this multicenter trial are presented in part I.1 Briefly, 690 men who had passed their 60th birthday and who met entry criteria for mild-to-moderate hypertension were randomly assigned to treatment with HCTZ (from 25 to 100 mg/day). Patients who achieved goal blood pressure of less than 90 mm Hg and at least a 5 mm Hg decline from baseline entered a 6-month maintenance period. Patients who did not achieve goal blood pressure were randomly assigned to treatment with by guest on May 11, 2018 http://hyper.ahajournals.org/ Downloaded from

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Hypertension: Cognitive and behavioral considerations

Cited by 22 publications

References 101 publications

Prehypertensive Blood Pressures and Regional Cerebral Blood Flow Independently Relate to Cognitive Performance in Midlife

Prehypertensive Blood Pressures and Regional Cerebral Blood Flow Independently Relate to Cognitive Performance in Midlife

A review of mild head trauma. part II: Clinical implications

Treatment of hypertension in the elderly: II. Cognitive and behavioral function. Results of a Department of Veterans Affairs Cooperative Study.

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