Vascular markers of cognitive dysfunction in patients with uncontrolled arterial hypertension

Abstract

The presence of arterial hypertension (AH) leads to the development of cognitive dysfunction, in the genesis of which a significant role is assigned to vascular factors. Aim. To study the state of cognitive function and associated vascular factors in patients with uncontrolled AH. Materials and methods. The research involved 88 patients with uncontrolled AH (UAH) — group 1 (median age 60, men — 39%) and 46 patients with controlled AH (CAH) — group 2 (median age 59, men — 41%). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). There were studied vascular factors: thickness of the intima-media complex (IMC), pulse wave velocity (PWV), microcirculation flow index (MFI) and asymmetric dimethylarginine (ADMA) concentrations. For the statistical analysis the following criteria were used: Student t-test, Mann—Whitney test. Multifactorial linear regression analysis was performed in groups. Results. In Group 1, there was a lower cognitive function index by MoCA — 24 [22; 26] points against 26 [25; 27] points in Group 2 (p = 0.002). IMC thickness was higher in Group 1 than in Group 2 (1.1 [0.90; 1.20] mm vs 1.0 [0.80; 1.10] mm, p = 0.042), concentration of ADMA was higher in Group 1 (0.73 ± 0.21 µmol/l vs 0.65 ± 0.1 µmol/l, p = 0.02), MFI was higher in Group 2 (30.6 [27.1; 34.4] perf. units vs. 22.8 [18.6; 26.1] perf. units, р < 0.001). No differences between the groups were found in PWV. In regression analysis, the following factors had a statistically significant effect on MoCA scores: in Group 1 — age, IMC thickness, ADMA and MFI; in Group 2 — age and glomerular filtrate rate. Conclusion. Patients with uncontrolled AH have more pronounced cognitive dysfunction than those with controlled AH, which is associated with increased IMC thickness, impaired microcirculation and increased ADMA concentration.

Compliance to treatment and its role in solving the problem of uncontrolled hypertension

“…Хорошо известно, что низкая приверженность к терапии является предиктором развития неконтролируемой АГ, гипертонических кризов, сердечно-сосудистых событий, ХБП [8]. При несоблюдении режима лечения и неконтролируемом течении продемонстрировано повышение жесткости сосудистой стенки, развитие гипертрофии левого желудочка (ГЛЖ), микроальбуминурии и когнитивной дисфункции [10,11]. Помимо этого, существует широкий спектр социальных последствий неприверженности к терапии: снижение качества жизни, повышение частоты обращаемости за медицинской помощью, потребности в госпитализации и уровня инвалидизации, а также ограничение работоспособности и возможностей самообслуживания [8].…”