title: Cognitive evolution in hypertensive patients: a six-year follow-up.
abstract: BACKGROUND
  Several studies have examined the links between hypertension, vascular damage, and cognitive impairment. The functions most commonly involved seem to be those associated with memory and executive function.
  
  
  OBJECTIVE
  1) to report the cognitive evolution in a cohort of hypertensive patients, 2) to identify the affected domains, and 3) to correlate the results obtained with blood pressure measurements.
  
  
  METHODS
  Observational 6-year follow-up cohort study including both males and females aged≥65 and ≤80 years, and hypertensive patients under treatment. Patients with a history of any of the following conditions were excluded: stroke, transient ischemic attack, diabetes mellitus, atrial fibrillation, cardiac surgery, dementia, or depression. Four neurocognitive evaluations were performed (at baseline and every 2 years). The tests used evaluated memory and executive function domain. Blood pressure was measured on every cognitive evaluation.
  
  
  RESULTS
  Sixty patients were followed for 76.4±2.8 months. The average age at baseline was 72.5±4.2 and 77.9±4.6 at 6 years (65% were women). Two patients were lost to follow up (3.3%) and 8 patients died (13.3%).The density incidence for dementia was 0.6% patients per year (pt/y) (n=3) and for depression was 1.6% pt/y (n=12). No changes were observed in either memory impairment or the Mini Mental State Examination (MMSE) results (p=ns) during follow-up. A progressive impairment of the executive function was shown regardless of the blood pressure measurements.
  
  
  CONCLUSIONS
  1) the incidence of dementia doubled to general population, 2) the initial memory impairment did not change during the evaluation period, 3) cognitive impairment worsened in the areas related to executive function (prefrontal cortex) regardless of the adequacy of anti-hypertensive treatment and blood pressure values.
authors: Department of Internal Medicine, Cardiovascular Division, Hospital Español de Buenos Aires, Argentina. augusto.vicario@gmail.com
authors: Augusto
authors: A
authors: Vicario
authors: Mildren A
authors: MA
authors: del Sueldo
authors: Judith M
authors: JM
authors: Zilberman
authors: Gustavo H
authors: GH
authors: Cerezo
references: Stroke. 2008 Feb;39(2):349-54
references: 18174483
references: Stroke. 2007 Jun;38(6):1766-73
references: 17510458
references: J Int Neuropsychol Soc. 2007 May;13(3):526-38
references: 17445302
references: Behav Neurosci. 2002 Jun;116(3):387-96
references: 12049319
references: Arch Neurol. 1993 Aug;50(8):873-80
references: 8352676
references: Lancet. 1996 Apr 27;347(9009):1141-5
references: 8609748
references: N Engl J Med. 2003 Mar 27;348(13):1215-22
references: 12660385
references: Am J Epidemiol. 1993 Sep 15;138(6):353-64
references: 8213741
references: J Clin Hypertens (Greenwich). 2005 Oct;7(10):598-604
references: 16227762
references: Br J Psychiatry. 1999 Apr;174:307-11
references: 10533549
references: Psychopharmacol Bull. 1988;24(4):699-702
references: 3074325
references: Science. 1971 May 28;172(3986):959-62
references: 5573571
references: Hypertension. 1998 Mar;31(3):780-6
references: 9495261
references: Brain. 2002 Apr;125(Pt 4):765-72
references: 11912110
references: J Psychiatr Res. 1975 Nov;12(3):189-98
references: 1202204
references: Dement Geriatr Cogn Disord. 2009;28(2):95-109
references: 19684399
references: Am J Epidemiol. 1997 Jun 15;145(12):1106-13
references: 9199540
references: Diabetes Care. 2000 Jan;23 Suppl 1:S4-19
references: 12017675
references: Neurobiol Aging. 2000 Jan-Feb;21(1):49-55
references: 10794848
references: Brain. 1965 Jun;88(2):237-94
references: 5318481
references: Biol Psychiatry. 2008 Apr 1;63(7):663-9
references: 17977521
references: Lancet. 2002 Dec 14;360(9349):1903-13
references: 12493255
references: J R Coll Gen Pract. 1988 Jul;38(312):311-3
references: 3255827
references: Mech Ageing Dev. 2001 Nov;122(16):2085-105
references: 11589925
references: J Hypertens. 2007 Sep;25(9):1751-62
references: 17762635
references: Cortex. 1989 Dec;25(4):687-95
references: 2612186