title: Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study.
abstract: BACKGROUND
  Our objective was to investigate the association between hypertension and concurrent impairments in mobility, cognition, and mood; the role of brain white matter hyperintensities in mediating this association; and the impact of these impairments on disability and mortality in elderly hypertensive individuals.
  
  
  RESULTS
  -Blood pressure, gait speed, digit symbol substitution test, and the Center for Epidemiological Studies Depression Scale were measured yearly (1992-1999) on 4700 participants in the Cardiovascular Health Study (age: 74.7, 58% women, 17% blacks, 68% hypertension, 3600 had brain magnetic resonance imaging in 1992-1993, survival data 1992-2005). Using latent profile analysis at baseline, we found that 498 (11%) subjects had concurrent impairments and 3086 (66%) were intact on all 3 measures. Between 1992 and 1999, 651 (21%) became impaired in all 3 domains. Hypertensive individuals were more likely to be impaired at baseline (odds ratio 1.23, 95% confidence interval 1.04 to 1.42, P=0.01) and become impaired during the follow-up (hazard ratio=1.3, 95% confidence interval 1.02 to 1.66, P=0.037). A greater degree of white matter hyperintensities was associated with impairments in the 3 domains (P=0.007) and mediated the association with hypertension (P=0.19 for hypertension after adjusting for white matter hyperintensities in the model, 21% hazard ratio change). Impairments in the 3 domains increased subsequent disability with hypertension (P<0.0001). Hypertension mortality also was increased in those impaired (compared with unimpaired hypertensive individuals: HR=1.10, 95% confidence interval 1.04 to 1.17, P=0.004).
  
  
  CONCLUSIONS
  Hypertension increases the risk of concurrent impairments in mobility, cognition, and mood, which increases disability and mortality. This association is mediated in part by microvascular brain injury.
authors.affiliation: Harvard Medical School, Institute for Aging Research/Hebrew SeniorLife, Division of Gerontology, Beth Israel Deaconess Medical Center, Boston MA, USA. ihabhajjar@hrca.harvard.edu
authors.forename: Ihab
authors.initials: I
authors.lastname: Hajjar
authors.forename: Lien
authors.initials: L
authors.lastname: Quach
authors.forename: Frances
authors.initials: F
authors.lastname: Yang
authors.forename: Paulo H M
authors.initials: PH
authors.lastname: Chaves
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mukamal
authors.forename: Will
authors.initials: W
authors.lastname: Longstreth
authors.forename: Marco
authors.initials: M
authors.lastname: Inzitari
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply; D003072:Cognition Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D051346:Mobility Limitation; D019964:Mood Disorders / Q000453:epidemiology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors