title: Independent association of cognitive dysfunction with cardiac hypertrophy irrespective of 24-h or sleep blood pressure in older hypertensives.
abstract: BACKGROUND
  Our aim was to assess whether cardiac hypertrophy is associated with cognitive function independently of office, 24-h, or sleep blood pressure (BP) levels in older hypertensive patients treated with antihypertensive medications.
  
  
  METHODS
  In this cross-sectional study, we recruited 443 hypertensive patients aged over 60 years (mean age: 73.0 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. They underwent measurements of 24-h BP monitoring, echocardiographic left ventricular mass index (LVMI), and cognitive function (mini-mental state examination, MMSE).
  
  
  RESULTS
  MMSE score was inversely associated with office, 24-h, awake, and sleep systolic BP (SBP) (each, P < 0.05). There was a close association between MMSE score and LVMI (ρ = -0.32; P < 0.001). Using multiple logistic regression analysis including numerous covariates (i.e., age, sex, obesity, current smoking, educational level, duration of antihypertensive medications, renal dysfunction, statin use, and previous history of cardiovascular disease), the odds ratio (OR) for the presence of cognitive dysfunction, defined as the lowest quartile of MMSE score (median MMSE score: 23 points; n = 115), was estimated; the presence of cardiac hypertrophy (LVMI ≥125 kg/m(2) in men and ≥110 kg/m(2) in women) as well as uncontrolled 24-h BP (mean 24-h SBP/diastolic BP (DBP) ≥130/80 mm Hg) or sleep BP (mean sleep SBP/DBP ≥120/70 mm Hg), but not uncontrolled office BP (mean office SBP/DBP ≥140/90 mm Hg), were independently associated with cognitive dysfunction (all P < 0.05).
  
  
  CONCLUSIONS
  Among older hypertensive patients with antihypertensive medications, those who had echocardiographically determined cardiac hypertrophy may be at high risk for cognitive dysfunction, irrespective of their office BP and 24-h BP levels.
authors.affiliation: Department of Internal Medicine, Kushima City Hospital, Miyazaki, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kuroki
authors.forename: Ryuji
authors.initials: R
authors.lastname: Inoue
authors.forename: Chihiro
authors.initials: C
authors.lastname: Nakanishi
authors.forename: Seiji
authors.initials: S
authors.lastname: Sagara
authors.forename: Masahiro
authors.initials: M
authors.lastname: Koga
authors.forename: Hirohide
authors.initials: H
authors.lastname: Kubo
authors.forename: Satoru
authors.initials: S
authors.lastname: Imakiire
authors.forename: Zyuntaro
authors.initials: Z
authors.lastname: Aoyagi
authors.forename: Michitaka
authors.initials: M
authors.lastname: Kitani
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kanemaru
authors.forename: Shirao
authors.initials: S
authors.lastname: Hidehito
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D006332:Cardiomegaly / Q000150:complications* / Q000000981:diagnostic imaging; D002940:Circadian Rhythm / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D007361:Intelligence Tests; D016015:Logistic Models; D008297:Male; D009819:Office Visits; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*
chemical_list: D000959:Antihypertensive Agents