title: Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients.
abstract: OBJECTIVE
  This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients.
  
  
  METHODS
  We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points).
  
  
  RESULTS
  CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction.
  
  
  CONCLUSIONS
  Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.
authors.affiliation: aAmerican Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA bDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi cDepartment of Orthopedics, Chikamorikai Medical Group, Kochi dTamaki Clinic eKijo Clinic fKuwabara Clinic gYokota Naika hEto Cardiology Clinic iKuroki Naika, Miyazaki, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Takashi
authors.initials: T
authors.lastname: Inokuchi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ohba
authors.forename: Noboru
authors.initials: N
authors.lastname: Tamaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nagata
authors.forename: Masachika
authors.initials: M
authors.lastname: Kuwabara
authors.forename: Naoto
authors.initials: N
authors.lastname: Yokota
authors.forename: Takuma
authors.initials: T
authors.lastname: Eto
authors.forename: Munetoshi
authors.initials: M
authors.lastname: Kuroki
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D003072:Cognition Disorders / Q000150:complications* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors