Preview

Sechenov Medical Journal

Advanced search

Vascular markers of cognitive dysfunction in patients with uncontrolled arterial hypertension

https://doi.org/10.47093/2218-7332.2020.11.3.26-36

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.

About the Authors

V. I. Podzolkov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Valery I. Podzolkov, Dr. of Sci. (Medicine), Professor, Head of the Department of Faculty Therapy No. 2; Director of the Faculty Therapy Clinic

8/2, Trubetskaya str., Moscow, 119991



A. E. Bragina
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Anna E. Bragina. Dr. of Sci. (Medicine), Professor, Department of Faculty Therapy No. 2

8/2, Trubetskaya str., Moscow, 119991



D. U. Natkina
Clinic for Preventive Medicine and Laboratory Diagnostics
Russian Federation

Dinara U. Natkina, cardiologist, doctor of functional diagnostics

14/3, Presnensky Val , Moscow, 123557

+7 (926) 721-01-22



N. A. Druzhinina
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Natalya A. Druzhinina, Cand. of Sci. (Medicine), Assistant Professor, Department of Faculty Therapy No. 2

8/2, Trubetskaya str., Moscow, 119991



T. A. Safronova
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Tatyana A. Safronova, Cand. of Sci. (Medicine), Associate Professor, Department of Faculty Therapy No. 2

8/2, Trubetskaya str., Moscow, 119991



References

1. 1 Oganov R.G., Maslennikova G.Ya. Demograficheskie tendentsii v Rossiiskoi Federatsii: vklad boleznei sistemy krovoobrashcheniya. [Demographic trends in the Russian Federation: the contribution of circulatory system diseases]. Cardiovascular therapy and prevention. 2012;1; 5–10 (In Russian). https://doi.org/10.15829/1728-8800-2012-1-5-10

2. 2 Emdin C.A., Rothwell P.M., Salimi-Khorshidi G., et al. Blood pressure and risk of vascular dementia: evidence from a primary care registry and a cohort study of transient ischemic attack and stroke. 2016; 47(6): 1429–35. https://doi.org/10.1161/STROKEAHA.116.012658 PMID: 27165956

3. 3 Snyder H.M., Corriveau R.A., Craft S., et al. Vascular contributions to cognitive impairment and dementia including Alzheimer’s disease. 2015; 11: 710–17. PMID: 25510382

4. 4 Iadecola C., Yaffe K., Biller J., et al. Impact of hypertension on cognitive function: a scientific statement from the American Heart Association. 2016; 68(6); е67–е94. https://doi.org/10.1161/HYP.0000000000000053 PMID: 27977393

5. 5 Levi Marpillat N., Macquin-Mavier I., Tropeano A.I., et al. Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens. 2013; 31(6): 1073– 82. https://doi.org/10.1097/HJH.0b013e3283603f53 PMID: 23552124

6. 6 Kjeldsen S.E., Narkiewicz K., Burnier M., et al. Intensive blood pressure lowering prevents mild cognitive impairment and possible dementia and slows development of white matter lesions in brain: the SPRINT memory and cognition IN decreased hypertension (SPRINT MIND) study. 2018; 27(5): 247–48. https://doi.org/10.1080/08037051.2018.1507621 PMID: 30175661

7. 7 Faraco G., Iadecola C. Hypertension: a harbinger of stroke and dementia. Hypertension. 2013; 62(5): 810–7. https://doi.org/10.1161/HYPERTENSIONAHA.113.01063 PMID: 23980072

8. 8 Qiu C., Fratiglioni L. A Major role for cardiovascular burden in age-related cognitive decline. 2015; 12(5): 267–77. https://doi.org/10.1038/nrcardio.2014.223 PMID: 25583619

9. 9 Kilander L., Niman N., Boberg M., et al. Vzaimosvyaz’ arterial’noi gipertenzii s kognitivnymi narusheniyami: Rezul’taty 20-letnego nablyudeniya 999 patsientov. [The relationship of hypertension with cognitive impairment: Results from a 20-year follow-up of 999 patients]. Clinical Cardiology Reviews. 2005; 2; 37–49 (In Russian).

10. 10 Orlova N.V., Karseladze N.D., Khachirova A.I., et al. Izuchenie vliyaniya mikrotsirkulyatsii i zhestkosti sosudov u bol’nykh arterial’noi gipertoniei na kognitivnye narusheniya. [Study of the effect of microcirculation and vascular stiffness in patients with arterial hypertension on cognitive impairment]. Sibirskii meditsinskii zhurnal = Siberian Medical Journal. 2014; 4: 119–22 (In Russian).

11. 11 Launer L.J., Hughes T., Yu B., et al. Lowering midlife levels of systolic blood pressure as a public health strategy to reduce late-life dementia: perspective from the Honolulu Heart Program/Honolulu Asia Aging Study. 2010; 55(6): 1352–9. https://doi.org/10.1161/HYPERTENSIONAHA.109.147389 PMID: 20404223

12. 12 Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018; 39(33): 3021–104. https://doi.org/10.1093/eurheartj/ehy339 PMID: 30165516

13. 13 Carson N., Leach L., Murphy K.J. A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry. 2018; 33(2): 379–88. https://doi.org/10.1002/gps.4756 PMID: 28731508

14. 14 Kozlov V.I., Azizov G.A., Gurova O.A., Litvin F.B. Lazernaya dopplerovskaya floumetriya v otsenke sostoyaniya i rasstroistv mikrotsirkulyatsii krovi. [Laser Doppler flowmetry in the assessment of the state and disorders of blood microcirculation]. Moscow, 2012. 32 p. URL: http://angiologia.ru/specialist/cathedra/recommendations/2012/001.pdf (In Russian).

15. 15 Xuan С., Xu L-Q., Tian Q-W., et al. Dimethylarginine dimethylaminohydrolase 2 (DDAH 2) gene polymorphism, asymmetric dimethylarginine (ADMA) concentrations, and risk of coronary artery disease: A case-control study. Sci Rep. 2016; 6: 33934. https://doi.org/10.1038/srep33934 PMID: 27677852

16. 16 Solov’eva A.P., Goryachev D.V., Arkhipov V.V. Kriterii otsenki kognitivnykh narusheniĬ v klinicheskikh issledovaniyakh. [Criteria for assessing cognitive impairment in clinical trials]. Vedomosti Nauchnogo tsentra ehkspertizy sredstv meditsinskogo primeneniya = The Bulletin of the Scientific Centre for Expert Evaluation of Medicinal Products. 2018; 8(4): 218–30 (In Russian). https://doi.org/10.30895/1991-2919-2018-8-4-218-230

17. 17 Skoog I., Lernfelt B., Landahl S., et al. 15-year longitudinal study of blood pressure and dementia. Lancet 1996; 347(9009): 1141–5. https://doi.org/10.1016/s0140-6736(96)90608-x PMID: 8609748

18. 18 Ruitenberg A., Skoog I., Ott A., et al. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study. Dementia Geriatr Cogn Disorders. 2001; 12(1): 33–9. https://doi.org/10.1159/000051233 PMID: 11125239

19. 19 Vallance P., Leone A., Calver A., et al. Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. Lancet. 1992; 339(8793): 572–75. https://doi.org/10.1016/0140-6736(92)90865-z PMID: 1347093

20. 20 Maksimovich N.E. Ponyatie o nitroksidergicheskoi sisteme mozga (rol’ neironal’nykh istochnikov). [The concept of the nitroxidergic system of the brain (the role of neuronal sources). Journal of the Grodno State Medical University. 2003; 4: 7–10 (In Russian).

21.


Supplementary files

Review

Views: 1022


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2218-7332 (Print)
ISSN 2658-3348 (Online)