V. Skybchyk¹, O. Pylypiv²

¹Danylo Halytsky Lviv National Medical University

²Municipal Enterprise Central City Hospital of Chervonograd City Council

Context. It is known that in addition to transient ischemic attacks and insults, hypertension is often the cause of asymptomatic brain damage, including cognitive impairment (CI). Most of these studies show a positive relationship between midlife hypertension and cognitive decline at the advanced age. CI significantly affect the quality of life of patients, reduce the ability to learn, acquire new knowledge and skills, force them to change their usual way of life and often stop or reduce professional activities. 

Objective. To analyze the condition of cognitive functions in patients with stage 1 and stage 2 hypertension of 2nd-3rd degrees, with moderate and high cardiovascular risk and evaluate their gender peculiarities.

Materials and methods. The study included 90 patients with stage 1 and stage 2 hypertension. The average age of patients with hypertension was 49.66 ± 8.74 years old. The average course of the disease was 7.7 ± 3.9 years. The comparison group consisted of 46 healthy individuals with normal blood pressure levels and without hypertension in anamnesis (the average age – 45.88 ± 3.03 years old). Applied methods included general clinical, methods of neuropsychological testing (MMSE, GPCOG, W. Schulte test), standard general clinical and biochemical laboratory methods (blood lipid spectrum, blood glucose, creatinine with GFR, electrolytes), instrumental (12-lead ECG, ambulatory monitoring of blood pressure, echocardiography in B-, D-modes), and statistical methods. 

Results. Patients with hypertension scored significantly less on the MMSE scale (26.82 ± 1.41 scores vs. 28.89 ± 0.82 scores, p = 0.001) and GPCOG (6.63 ± 1.88 scores vs. 8.35 ± 0.71 scores, p = 0.001) compared with healthy individuals and spent more time on performing Walter Schulte test (46.51 ± 8.59 seconds vs. 36.69 ± 6.77 seconds, p = 0.001). Moderate CI were detected in 36 patients (40.00 %) among the examined hypertensive patients; it means that the total score of MMSE was 24-26 scores (the norm is 27-30 scores). The total score on the MMSE scale was 25.47 ± 0.88 in hypertensive patients with CI and was significantly lower than in hypertensive patients without CI (р = 0.001). Cognitive functions in patients with CI were characterized by poorer indices of memory, counting and executive functions. 

It should be noted that the revealed changes had more reliable manifestations  in male hypertensive patients. In particular, the total score on the MMSE scale was 26.57 ± 1.37, while in female ones it was 27.19 ± 1.41 scores (p = 0.04). CI on the MMSE scale were diagnosed in 43.4 % (n = 23) of male patients and in 35.1 % (n = 13) of female patients. The total score was also higher on the GPCOG scale in female patients – 6.89 ± 1.85 scores vs. 6.45 ± 1.89 scores, p = 0.26. Instead, the time to complete the tasks according to the Walter Schulte tables was longer in male patients – 47.74 ± 8.85 seconds vs. 47.73 ± 7.99 seconds, p = 0.10, respectively. The parameters of counting functions were significantly lower (p = 0.01) in the group of male hypertensive patients compared with female ones. Besides, men had lower indicators of short-term memory and orientation, women reproduced worse verbal material, but the difference was statistically insignificant (p > 0.05).

The sum of scores on the MMSE scale conversely correlated with male gender (r = -0.22, p = 0.03). The risk of low values of MMSE indices ​​in male patients with hypertension was 42.00 % higher than in female ones (OR = 1.42 ± 0.32, with 95% CІ [0.18-2.65]).

Conclusions. Hypertension is a significant independent risk factor for developing new cases of cognitive impairment. In particular, among the patients with stage 1 and stage 2 hypertension of 2nd-3rd degrees, with moderate and high cardiovascular risk, moderate cognitive impairment was revealed in 36 patients (40,00 %), the revealed changes were more manifested in male hypertensive patients.

References

1. Boev SS, Dotsenko MYa, Shekhunova IO, Dedova VO, Herasimenko LV. Correction and treatment of moderate cognitive impairment in patients with arterial hypertension. Rational Pharmacotherapy. 2015;3(36):55-60 (Ukrainian)
2. Ministry of Health of Ukraine. Order of the Ministry of Health of Ukraine dated 19.07.2016 № 736 “On approval and implementation of medical and technological documents for standardization of medical care for dementia”. 2016 (Ukrainian)
3. Mishchenko LA, Hulkevich OV. Cardiocerebral continuum in arterial hypertension: ways of correction. International Journal of Neurology. 2019;1(103):60-65 (Ukrainian) https://doi.org/10.22141/2224-0713.1.103.2019.158640
4. Starchina YuA. Non-dementia cognitive impairment: a modern view on the problem. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(2):71-76 (Russian) https://doi.org/10.14412/2074-2711-2017-2-71-76
5. Hughes TM, Sink KM. Hypertension and its role in cognitive function: current evidence and challenges for the future. Am J Hypertens. 2016;29:149-157. https://doi.org/10.1093/ajh/hpv180
6. Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB et al. Impact of hypertension on cognitive function: a scientific statement from the American Heart Association. Hypertension. 2016;68:e67-e94. https://doi.org/10.1161/HYP.0000000000000053
7. Kimm H, Lee PH, Shin YJ, Park KS, Jo J, Lee Y et al. Midl-life and late-life vascular risk factors and dementia in Korean men and women. Arch Gerontol Geriatr. 2011;52(3):117-122. https://doi.org/10.1016/j.archger.2010.09.004
8. Yasar S, Schuchman M, Peters J, Anstey KJ, Carlson MC, Peters R. Relationship between antihypertensive medications and cognitive impairment: Part I. Review of human studies and clinical trials. Curr Hypertens Rep. 2016;18(8):67. https://doi.org/10.1007/s11906-016-0674-1