Mergeani Athena Cristina, Antochi Florina, Rusu Octavia, Ciobotaru Andrei, Coclitu Catalina, Bajenaru Ovidiu Alexndru
Emergency University Hospital, Bucharest, Romania.
Maedica (Bucur). 2015 Sep;10(4):325-330.
Cognitive impairment is strongly associated with arterial hypertension and might be associated also with certain circadian blood pressure patterns. Ambulatory blood pressure monitoring (ABPM) represents a very useful tool in the evaluation of patients with hypertension. Intima-media thickness (IMT), a marker of subclinical organ damage in hypertensive patients is associated with the progression of cognitive impairment. The aim of our study was to correlate the cognitive impairment with the hypertension pattern found with ABPM, IMT, lipid profile and inflammatory syndrome.
We enrolled 40 patients aged between 47 and 88 years (69±11 years) with medical history of essential hypertension and cognitive impairment. All patients underwent neuropsychological examination, ABPM, and B-mode ultrasound of the carotid arteries.
57% of the patients had a nondipping pattern. The blood pressure pattern inversely correlated with the results of MMSE (r=-0.33; p=0.04), patients with nondipping patterns having lower scores than the ones with dipper pattern. Increased IMT was associated with poorer performance on MoCA test (r=-0.33; p=0.005). MoCA and MMSE scores were inversely correlated with the total cholesterol (r=-0.31; p=0.04; and r=0.38; p=0.01 respectively) and with the LDL-cholesterol (r=-0.32; p=0.04; and r=-0.41; p=0.009 respectively). Patients with low scores on MMSE also had high serum levels of C reactive protein (r=-0.33; p=0.045).
Patients with cognitive impairment and hypertension have vascular changes characterized by increased carotid IMT, alteration of the dipping phenomenon, increased total and LDL-cholesterol, and increased C reactive protein, all related to the degree of cognitive dysfunction.
认知障碍与动脉高血压密切相关，也可能与某些昼夜血压模式有关。动态血压监测（ABPM）是评估高血压患者的一项非常有用的工具。内膜中层厚度（IMT）是高血压患者亚临床器官损伤的一个标志物，与认知障碍的进展相关。我们研究的目的是将认知障碍与通过ABPM发现的高血压模式、IMT、血脂谱和炎症综合征相关联。
我们纳入了40名年龄在47至88岁（平均69±11岁）之间、有原发性高血压病史和认知障碍的患者。所有患者均接受了神经心理学检查、ABPM以及颈动脉B超检查。
57%的患者呈现非勺型血压模式。血压模式与简易精神状态检查表（MMSE）结果呈负相关（r=-0.33；p=0.04），非勺型模式患者的得分低于勺型模式患者。IMT增加与蒙特利尔认知评估量表（MoCA）测试表现较差相关（r=-0.33；p=0.005）。MoCA和MMSE得分与总胆固醇呈负相关（分别为r=-0.31；p=0.04和r=0.38；p=0.01），与低密度脂蛋白胆固醇也呈负相关（分别为r=-0.32；p=0.04和r=-0.41；p=0.009）。MMSE得分低的患者血清C反应蛋白水平也较高（r=-0.33；p=0.045）。
患有认知障碍和高血压的患者存在血管变化，其特征为颈动脉IMT增加、勺型现象改变、总胆固醇和低密度脂蛋白胆固醇升高以及C反应蛋白增加，所有这些都与认知功能障碍的程度相关。
