Acessibilidade / Reportar erro

Brasil

Dementia & Neuropsychologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Dement. neuropsychol. 11 (4) • Oct-Dec 2017 • https://doi.org/10.1590/1980-57642016dn11-040008 copy

Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance

IMPACTO DA GRAVIDADE DA HIPERTENSÃO NA RIGIDEZ ARTERIAL, VASORREATIVIDADE CEREBRAL E DESEMPENHO COGNITIVO

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall.

Objective:

To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension.

Methods:

211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior^®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography.

Results:

Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests.

Conclusion:

Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.

Key words:
hypertension; vascular changes; arterial stiffness; cerebral blood flow; cognitive performance

Variable		Normotension (69)	HTN stage 1 (83)	HTN stage 2 (59)	p
Age (Years), mean ± SD		52.2 ± 13.9	52.4 ± 13.2	50.9 ± 10.3	0.78
Sex, female (no, %)		38 (55.1)	47 (56.6)	31 (52.5)	0.89
Race, white (no, %)		44 (63.8)	64 (77.1)	36 (61.0)	0.07
Married, (no, %)		35 (50.7)	55 (66.3)	33 (55.9)	0.09
Weight (kg), mean ± SD		74.3 ± 16.2	77.1 ± 14.2	83.1 ± 13.7	0.004^a a Normotension vs. HTN stage-2.
Height, (m), mean ± SD		1.7 ± 0.1	1.6 ± 0.9	1.7 ± 0.1	0.52
BMI (kg/m²), mean ± SD		26.7 ± 4.2	28.4 ± 4.6	30.2 ± 4.5	< 0.001^a a Normotension vs. HTN stage-2.
Education (years), mean ± SD		13.0 ± 3.9	11.4 ± 4.4	10.0 ± 4.2	< 0.001^a a Normotension vs. HTN stage-2.
Monthly income, median (range) (R$)		3000 (730-15000)	2000 (600-8500)	1900 (500-20000)	0.02a
SBP (mmHg), mean ± SD		121.9 ± 8.3	134.1 ± 13.9	148.1 ± 24.7	< 0.001^b b All groups different.
DBP (mmHg), mean ± SD		76.5 ± 6.7	82.1 ± 9.8	91.3 ± 13.5	< 0.001^b b All groups different.
HTN time (years), median (range)		–	8.0 (1-37)	10.0 (1-36)	< 0.001
Number of drugs, mean ± SD		–	1.42 ± 0.8	3.8 ± 1.2	< 0.001
BP control, (no, %)		–	47 (56.6)	21 (35.6)	0.01
Most used drugs	ARB, (no, %)	–	37 (32.5)	30 (50.1)	0.03
	ACEI, (no, %)	–	30 (36.1)	26 (44.1)	0.34
	Diuretics, (no, %)	–	38 (45.8)	52 (88.1)	< 0.001
	CCB, (no, %)	–	10 (12.0)	46 (78.0)	< 0.001
	BB, (no, %)	–	10 (12.0)	37 (62.7)	< 0.001

Variable – mean ± SD		Normotension (57)	HTN stage 1 (72)	HTN stage 2 (51)	p
Resting (Middle cerebral artery)	Initial velocity (m/s)	57.2 ± 10.8	52.2 ± 13.9	56.5 ± 13.7	0.76
Resting (Middle cerebral artery)	Final velocity (m/s)	59.3 ± 12.8	60.3 ± 15.5	57.9 ± 13.7	0.66
Apnea maneuver	Initial velocity (m/s)	57.9 ± 12.3	59.9 ± 12.3	58.4 ± 14.4	0.68
	Final velocity (m/s)	81.5 ± 20.1	79.2 ± 18.4	75.4 ± 20.9	0.29
	Breath-holding index	1.4 ± 0.6	1.1 ± 0.6	1.0 ± 0.6	0.004a
Handgrip maneuver	Initial velocity (m/s)	59.1 ± 12.3	60.3 ± 14.3	56.9 ± 15.3	0.43
Handgrip maneuver	Final velocity (m/s)	63.6 ± 15.3	63.9 ± 17.3	60.7 ± 19.0	0.57

Variable – mean ± SD	Normotension (69)	HTN stage 1 (83)	HTN stage 2 (59)	p
Diameter, mm	6.5 ± 0.6	7.0 ± 0.8	7.2 ± 0.7	< 0.001^a a Normotension vs. HTN stage 2;
Distension, %	4.8 ± 2.1	4.7 ± 2.2	5.0 ± 1.7	0.572
IMT, mm	0.7 ± 0.1	0.8 ± 0.1	0.8 ± 0.1	0.003^a a Normotension vs. HTN stage 2;
PWV, m/s	7.5 ± 1.4	7.9 ± 1.2	8.0 ± 1.3	0.100
AIx	22.3 ± 12.9	24.7 ± 12.2	30.4 ± 11.9	0.001^b b Normotension vs. HTN stage 1 and HTN stage 2;
Alx75	21.1 ± 12.0	24.2 ± 9.9	25.8 ± 9.8	0.038^c c HTN stage 2 vs. normotension and HTN stage 1;
cSBP, mmHg	111.5 ± 9.5	121.1 ± 14.6	141.1 ± 32.6	< 0.001^d d All groups different.
cDBP, mmHg	76.7 ± 7.8	83.0 ± 10.5	92.7 ± 17.1	< 0.001^d d All groups different.

Cognitive Domain – mean ± SD	Normotension (69)	HTN stage 1 (83)	HTN stage 2 (59)	p
MMSE	28.0 ± 2.0	27.4 ± 2.1	26.9 ± 2.0	0.004^a a Normotension vs. HTN stage 2.
MoCA	25.6 ± 3.0	24.87 ± 3.0	23.8 ± 3.4	0.003^a a Normotension vs. HTN stage 2.
Global cognitive function	0.02 ± 0.6	–0.3 ± 0.7	–0.4 ± 0.7	< 0.001^b b Normotension vs. HTN stage 1 and HTN stage 2.
Language	0.01 ± 1.0	–0.3 ± 1.1	–0.5 ± 1.4	0.038^a a Normotension vs. HTN stage 2.
Memory	0.03 ± 0.8	–0.2 ± 1.1	–0.4 ± 1.0	0.019^a a Normotension vs. HTN stage 2.
Executive function	0.01 ± 0.8	–0.4 ± 0.8	–0.5 ± 0.6	< 0.001^b b Normotension vs. HTN stage 1 and HTN stage 2.
Visuospatial abilities	0.02 ± 0.9	–0.2 ± 0.8	–0.4 ± 1.0	0.047^a a Normotension vs. HTN stage 2.
Attention	0.03 ± 0.7	–0.3 ± 0.8	–0.4 ± 0.9	0.007^a a Normotension vs. HTN stage 2.
Processing Speed	0.03 ± 1.0	–0.4 ± 0.9	–0.6 ± 0.9	< 0.001^b b Normotension vs. HTN stage 1 and HTN stage 2.

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

Acompanhe os números deste periódico no seu leitor de RSS