Neuroscience Research Australia, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia.
University of New South Wales, Sydney, NSW, 2052, Australia.
J Hum Hypertens. 2023 Apr;37(4):307-312. doi: 10.1038/s41371-022-00681-1. Epub 2022 Apr 1.
The association between raised blood pressure and increased risk of subsequent cognitive decline is well known. Left ventricular hypertrophy (LVH), as a marker of hypertensive target organ damage, may help identify those at risk of cognitive decline. We assessed whether LVH was associated with subsequent cognitive decline or dementia in hypertensive participants aged ≥80 years in the randomized, placebo-controlled Hypertension in the Very Elderly Trial. LVH was assessed using 12-lead electrocardiography (ECG) based on the Cornell Product (CP-LVH), Sokolow-Lyon (SL-LVH), and Cornell Voltage (CV-LVH) criteria. The Mini-Mental State Examination (MMSE) was used to assess cognitive function at baseline and annually. A fall in MMSE to <24 or an annual fall of >3 points were defined as cognitive decline and triggered dementia screening (Diagnostic Statistical Manual IV). Death was defined as a competing event. Fine-Gray regression models were used to examine the relationship between baseline LVH and cognitive outcomes. There were 2645 in the analytical sample, including 201 (7.6%) with CP-LVH, 225 (8.5%) SL-LVH and 251 (9.5%) CV-LVH. CP-LVH was associated with increased risk of cognitive decline, subdistribution hazard ratio (sHR)1.3 (95% confidence interval (CI) 1.01-1.67) in multivariate analyses. SL-LVH and CV-LVH were not associated with cognitive decline (sHR1.06 (95% CI 0.82-1.37) and sHR1.13 (95% CI 0.89-1.43), respectively). LVH was not associated with dementia. LVH may be related to subsequent cognitive decline, but evidence was inconsistent depending on ECG criterion and there were no associations with incident dementia. Additional work is needed to understand the relationships between blood pressure, LVH assessment and cognition.
血压升高与随后认知能力下降风险增加之间的关联是众所周知的。左心室肥厚（LVH）作为高血压靶器官损害的标志物，可能有助于识别那些有认知能力下降风险的人。我们评估了在高血压高龄患者随机、安慰剂对照的高血压高龄患者试验中，LVH 是否与随后的认知能力下降或痴呆有关。LVH 使用基于科奈尔产品（CP-LVH）、索科洛夫-莱昂（SL-LVH）和科奈尔电压（CV-LVH）标准的 12 导联心电图（ECG）进行评估。在基线和每年使用简易精神状态检查（MMSE）评估认知功能。MMSE 下降到<24 或每年下降>3 分被定义为认知下降，并触发痴呆筛查（诊断统计手册第四版）。死亡被定义为竞争事件。精细灰色回归模型用于检查基线 LVH 与认知结果之间的关系。在分析样本中，有 2645 例患者，包括 201 例（7.6%）CP-LVH、225 例（8.5%）SL-LVH 和 251 例（9.5%）CV-LVH。多变量分析中，CP-LVH 与认知下降风险增加相关，亚分布危险比（sHR）为 1.3（95%置信区间[CI] 1.01-1.67）。SL-LVH 和 CV-LVH 与认知下降无关（sHR1.06[95%CI 0.82-1.37]和 sHR1.13[95%CI 0.89-1.43]）。LVH 与痴呆无关。LVH 可能与随后的认知能力下降有关，但根据心电图标准，证据不一致，与痴呆的发生无关。需要进一步研究以了解血压、LVH 评估和认知之间的关系。
