Department of Cardiovascular Medicine, The University of Tokushima Graduate School of Health Biosciences, Tokushima, Japan.
Hypertens Res. 2011 Jan;34(1):74-8. doi: 10.1038/hr.2010.179. Epub 2010 Sep 23.
Cognitive impairment leading to dementia is associated with high prevalence of hypertension, decreased quality of life and poor prognosis. Aldosterone is known as a risk factor for cardiovascular and cerebrovascular diseases. In addition, mineral corticoid receptors are abundantly expressed in the hippocampus, which plays a pivotal role in cognitive function; however, it has not been determined whether plasma aldosterone level is associated with cognitive impairment in patients with hypertension. We enrolled 68 patients with essential hypertension and assessed their cardiovascular risk factors, including blood pressure, hyperlipidemia, diabetes mellitus, obesity, smoking, history of cerebral infarction, renal function, parameters of inflammation, oxidative stress and nitric oxide bioavailability, a parameter of cerebral blood flow and carotid plaque by ultrasound examination, plasma renin activity and plasma aldosterone concentration (PAC). The mini-mental state examination (MMSE) was used to evaluate cognitive function. The relevance of cardiovascular risk factors and MMSE score was statistically evaluated. Multiple regression analysis showed that age (P < 0.01), PAC (P < 0.01) and history of cerebral infarction (P < 0.05) were inversely and independently associated with MMSE score. Mineral corticoid receptor antagonists, including spironolactone and eplerenone, increased MMSE score in seven patients with hypertension, but not in the controls. In conclusion, increased PAC is associated with impaired cognitive function and mineral corticoid receptor blockade may protect against not only cardiovascular mortality, but also cognitive impairment in patients with hypertension.
认知障碍导致痴呆与高血压的高患病率、生活质量下降和预后不良有关。醛固酮被认为是心血管和脑血管疾病的危险因素。此外，矿皮质激素受体在海马中大量表达，海马在认知功能中起着关键作用；然而，尚未确定高血压患者的血浆醛固酮水平是否与认知障碍有关。我们招募了 68 名原发性高血压患者，评估了他们的心血管危险因素，包括血压、高血脂、糖尿病、肥胖、吸烟、脑梗死史、肾功能、炎症、氧化应激和一氧化氮生物利用度参数、脑血流参数和颈动脉斑块通过超声检查、血浆肾素活性和血浆醛固酮浓度（PAC）。采用简易精神状态检查（MMSE）评估认知功能。统计评估心血管危险因素与 MMSE 评分的相关性。多元回归分析表明，年龄（P<0.01）、PAC（P<0.01）和脑梗死史（P<0.05）与 MMSE 评分呈负相关且独立相关。螺内酯和依普利酮等矿皮质激素受体拮抗剂可增加 7 例高血压患者的 MMSE 评分，但对对照组无影响。总之，PAC 的增加与认知功能障碍有关，矿皮质激素受体阻断可能不仅能预防心血管死亡率，还能预防高血压患者的认知障碍。
