Vascular structure and function is correlated to cognitive performance and white matter hyperintensities in older hypertensive patients with subjective memory complaints.
OBJECTIVE
Arterial stiffening and thickening and endothelial dysfunction may be associated with cognitive decline or white matter hyperintensities (WMH) independently of blood pressure level. We aimed to investigate, using an integrative approach, the relative contributions of structural and functional vascular factors to the degree of cognitive impairment (primary outcome) and the severity of WMH (secondary outcome) in elderly hypertensive patients with subjective memory complaints, a group prone to dementia.


METHODS
A prospective, dedicated, cross-sectional population of 198 elderly hypertensive patients (mean age 69.3+/-6.2 years) with subjective memory complaints underwent a full set of cognitive function assessments, brain MRI with semiquantification of WMH, carotid ultrasonography, carotid-femoral pulse wave velocity, brachial endothelial function, and plasma von Willebrand Factor measurements.


RESULTS
After adjustment for the usual cardiovascular risk factors, increased arterial stiffness (as assessed by pulse wave velocity) was significantly and independently associated with memory impairment in men. The severity of WMH was independently associated with increased carotid intima media thickness and stiffness (as assessed by augmentation index) as well as with increased age and plasma levels of von Willebrand Factor, a biomarker of endothelial dysfunction.


CONCLUSIONS
Our data suggest that vascular abnormalities, independently of blood pressure levels, may play a role in the setting of subjective memory complaints as well as of WMH in elderly hypertensive patients. Arterial thickness and stiffness as well as endothelial function should be assessed simultaneously and may represent additional targets for the prevention of subjective memory complaints and WMH.
Kearney-Schwartz
Anna
A
Nancy University Hospital, Clinical Investigation Centre, J d'Arc Hospital, Dommartin lès Toul, France.
Rossignol
Patrick
P
Bracard
Serge
S
Felblinger
Jacques
J
Fay
Renaud
R
Boivin
Jean-Marc
JM
Lecompte
Thomas
T
Lacolley
Patrick
P
Benetos
Athanase
A
Zannad
Faiez
F
D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000473:pathology; D002560:Cerebrovascular Circulation; D003072:Cognition Disorders / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000473:pathology / Q000502:physiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D049292:Leukoaraiosis / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D011673:Pulsatile Flow; D012307:Risk Factors; D012720:Severity of Illness Index