Osovska Natalia Y, Mazur Yulia V, Bereziuk Olga M, Dmytryshyn Serhii P, Velychkovych Maryna M, Perebetiuk Larysa A, Temna Olena V, Honcharenko Oksana M, Furman Oksana V, Balatskyi Oleksiy R
National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
Wiad Lek. 2019;72(4):670-676.
Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension.
Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data.
Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree.
Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.
引言：最近，血管性认知障碍这一概念正在积极发展，它涵盖了因脑血管供血不足导致的所有认知功能衰退变体。这一概念远远超出了关于血管性认知障碍问题的传统既有观念。本研究的目的是证明高血压患者心血管系统结构和功能重塑指标与智力记忆功能状态之间的相关性。
材料与方法：对146例根据ESH/ESC 2013、2017、2018标准诊断为II期和III期高血压的患者进行了全面检查。该研究纳入了轻度和中度认知障碍（CI）患者。根据认知领域的状态以及神经心理学测试结果，将患者分为3组，并进一步比较他们的临床和仪器检查数据。
结果：根据我们的研究结果，发现认知活动变化更明显的患者心血管重塑迹象增加。对研究组患者的心内血流动力学参数分析显示，认知障碍患者的病理变化比无认知障碍患者更显著。轻度和中度CI患者的心率、左心室壁厚度（LV）显著更高，这导致左心室舒张功能受损，且在无认知功能障碍的患者中也已出现。此外，随着认知障碍的出现（轻度）和程度加重（中度），其有所增加。所有研究组患者的每日血压平均值（收缩压、舒张压）均显著超过推荐标准，而中度CI患者的这些数值显著高于轻度CI组（p = 0.028）。此外，随着患者认知功能的恶化，收缩压变异性同时增加。在研究外周血管状态时也观察到重塑迹象（外周阻力增加、搏动指数、线性速度以及内膜 - 中膜复合体增厚），这是认知障碍的主要原因，导致其出现并反映其程度。
结论：本研究揭示了认知障碍程度与每日血压曲线变化程度之间存在明显相关性，其中最重要的是每日平均收缩压和收缩压变异性。基于所进行的研究，未来有可能根据每日血压曲线状态、心室和血管几何形状的变化来预测认知领域受累程度，这将有助于及时诊断认知障碍并开出适当的治疗方案。
