Hypertension‐induced subclinical vascular and cognitive changes are reversible—An observational cohort study

Abstract

Beside the well-known complications of poorly controlled, long-standing hypertension, milder abnormalities induced by early-stage hypertension have also been described. In our study, the authors examined the reversibility of changes induced by early-stage hypertension. The authors performed laboratory testing, ambulatory blood pressure monitoring, carotid intima-media thickness (IMT) measurement, evaluation of stiffness parameters, assessment of various cardiac and cerebral hemodynamic parameters during head-up tilt table (HUTT) testing, and neuropsychological examinations in 49 recently diagnosed hypertensive patients. Following baseline assessment, antihypertensive therapy was commenced. After one year of therapy, lower IMT values were found. Pulse wave velocity showed a borderline significant decrease. During HUTT, several hemodynamic parameters improved. The patients performed better on neuropsychological testing and reached significantly lower scores on questionnaires evaluating anxiety. The present study shows that early vascular changes and altered cognitive function observed in newly diagnosed hypertensive patients may improve with promptly initiated antihypertensive management. | INTRODUC TI ONHypertension is one of the leading risk factors of cardio-and cerebrovascular diseases. The devastating, long-term complications of untreated or ineffectively controlled hypertension are well known. 1 Moreover, the importance of asymptomatic organ damage has also been recognized and thoroughly discussed previously. 2 Manifest cardiovascular events are preceded by progressive, subclinical deterioration of the arterial wall, which can be visualized by measuring the intima-media thickness (IMT) by B-mode ultrasonography. 3 | 659 CZURIGA-KOVÁCS et Al.

Long-term effect of masked hypertension management on cognitive functions in geriatric age: geriatric MASked hypertension and cognition follow-up study (G-MASH-cog MONITOR)

“…Finally, in a study examining the reversibility of subclinical vascular and cognitive changes with antihypertensive treatment in newly diagnosed hypertensive patients Czuriga-Kovács et al . [34] found that patients performed better on neuropsychological assessment when compared to baseline after 1-year antihypertensive therapy, which was consistent with the present study results. Based on these results, future studies including patients with masked hypertension, newly diagnosed and long-term hypertension, can clarify this complex association in order to determine (1) whether the improvement with antihypertensive treatment in cognitive functions depends on the duration of hypertension, and (2) whether the improvement with antihypertensive treatment in cognitive functions in masked hypertensive and newly diagnosed hypertensive patients will deteriorate with time.…”

Influence of angiotensin-converting enzyme inhibition on reversibility of alterations in arterial wall and cognitive performance associated with early hypertension

“…[27] Our research group reported previously that 1-year antihypertensive therapy results in significant improvement in vascular wall structure demonstrated by the reduction in carotid IMT. [28] In our present study, the reductive effect of 3-month ACE inhibition on carotid IMT did not reach a significant level.…”

“…[38] A previous investigation by our study group showed that after 1 year of appropriate and effective antihypertensive therapy, normalized blood pressure was accompanied by an improved cognitive performance. [28] Although some studies provided hints that certain classes of antihypertensive drugs may be more effective than others at improving cognition or reducing cognitive decline, [39–41] most of these studies were underpowered or without equivalent cognitive endpoints. [13] The current study demonstrated that the applied short-term (3-month) antihypertensive treatment with ACE inhibitors resulted in a significant improvement in executive function.…”

Reply to letter: Reversibility of hypertension‐induced subclinical vascular changes: Do the new ACC/AHA 2017 blood pressure guidelines and heart rate changes make a difference?

“…5 Therefore, the two guidelines share similar recommendations from the clinical point of view; the difference between them is the labeling of patients and the nomenclature used to define categories.Accordingly, our data also imply that better results in intimamedia thickness (IMT) reduction may be achieved when hypertension is treated at an earlier rather than a more advanced stage, as the reduction in IMT was more pronounced in patients with a mean blood pressure level below the median value at baseline. 6 One could say that the milder the blood pressure elevation, the better the reversibility of target organ damage represented by IMT.Regarding our study cohort, only three patients were recommended solely lifestyle changes without any drug therapy. It is unlikely that these patients were at high or very high risk as diabetic patients or those with any severe comorbidity had been excluded from the investigations.…”

“…Accordingly, our data also imply that better results in intimamedia thickness (IMT) reduction may be achieved when hypertension is treated at an earlier rather than a more advanced stage, as the reduction in IMT was more pronounced in patients with a mean blood pressure level below the median value at baseline. 6 One could say that the milder the blood pressure elevation, the better the reversibility of target organ damage represented by IMT.…”