Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients
OBJECTIVES:This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients. METHODS:We rec...
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| Veröffentlicht in: | Journal of hypertension 2014-02, Vol.32 (2), p.423-431 |
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| container_title | Journal of hypertension |
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| creator | Yano, Yuichiro Bakris, George L Inokuchi, Takashi Ohba, Yusuke Tamaki, Noboru Nagata, Masahiko Kuwabara, Masachika Yokota, Naoto Eto, Takuma Kuroki, Munetoshi Shimada, Kazuyuki Kario, Kazuomi |
| description | OBJECTIVES:This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients.
METHODS:We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points).
RESULTS:CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P |
| doi_str_mv | 10.1097/HJH.0000000000000025 |
| format | Article |
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METHODS:We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points).
RESULTS:CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima–media thickness (IMT)], hazard ratio 2.5–2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction.
CONCLUSION:Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.</description><identifier>ISSN: 0263-6352</identifier><identifier>EISSN: 1473-5598</identifier><identifier>DOI: 10.1097/HJH.0000000000000025</identifier><identifier>PMID: 24351802</identifier><language>eng</language><publisher>England: Wolters Kluwer Health | Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Blood Pressure ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - physiopathology ; Cardiovascular Diseases - psychology ; Cognition Disorders - complications ; Cognition Disorders - psychology ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Hypertension - complications ; Hypertension - physiopathology ; Hypertension - psychology ; Male ; Mental Status Schedule ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Risk Factors</subject><ispartof>Journal of hypertension, 2014-02, Vol.32 (2), p.423-431</ispartof><rights>2014 Wolters Kluwer Health | Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3565-7650b4cd3d661e159b79998efcbda794f25b81bb1fa24b0075c23c13d77177e83</citedby><cites>FETCH-LOGICAL-c3565-7650b4cd3d661e159b79998efcbda794f25b81bb1fa24b0075c23c13d77177e83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24351802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yano, Yuichiro</creatorcontrib><creatorcontrib>Bakris, George L</creatorcontrib><creatorcontrib>Inokuchi, Takashi</creatorcontrib><creatorcontrib>Ohba, Yusuke</creatorcontrib><creatorcontrib>Tamaki, Noboru</creatorcontrib><creatorcontrib>Nagata, Masahiko</creatorcontrib><creatorcontrib>Kuwabara, Masachika</creatorcontrib><creatorcontrib>Yokota, Naoto</creatorcontrib><creatorcontrib>Eto, Takuma</creatorcontrib><creatorcontrib>Kuroki, Munetoshi</creatorcontrib><creatorcontrib>Shimada, Kazuyuki</creatorcontrib><creatorcontrib>Kario, Kazuomi</creatorcontrib><title>Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients</title><title>Journal of hypertension</title><addtitle>J Hypertens</addtitle><description>OBJECTIVES:This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients.
METHODS:We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points).
RESULTS:CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima–media thickness (IMT)], hazard ratio 2.5–2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction.
CONCLUSION:Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Pressure</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - physiopathology</subject><subject>Cardiovascular Diseases - psychology</subject><subject>Cognition Disorders - complications</subject><subject>Cognition Disorders - psychology</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertension - physiopathology</subject><subject>Hypertension - psychology</subject><subject>Male</subject><subject>Mental Status Schedule</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Risk Factors</subject><issn>0263-6352</issn><issn>1473-5598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1P4zAQhi3ECsrHP0DIRy7p2nEcx0eEYAtC2svuOXLsCTG4cfEkrfrvSbeABIf1ZQ5-3mc0LyEXnM050-rn4mExZ19eLg_IjBdKZFLq6pDMWF6KrBQyPyYniM8TUmkljshxXgjJK5bPSHeNGK03g489jS218an3g18DdVtsx97--9j4oaPWJOfj2qAdg0nUeQSDQGEN_YDU9xSCgxS2tNuuIA3Q406zmtQ74Iz8aE1AOH-fp-Tv3e2fm0X2-PvX_c31Y2aFLGWmSsmawjrhypIDl7pRWusKWts4o3TR5rKpeNPw1uRFw5iSNheWC6cUVwoqcUqu9t5Viq8j4FAvPVoIwfQQR6x5oafQdP8OLfaoTRExQVuvkl-atK05q3cd11PH9feOp9jl-4axWYL7DH2UOgHVHtjEMEDClzBuINUdmDB0_3e_AcBdijc</recordid><startdate>201402</startdate><enddate>201402</enddate><creator>Yano, Yuichiro</creator><creator>Bakris, George L</creator><creator>Inokuchi, Takashi</creator><creator>Ohba, Yusuke</creator><creator>Tamaki, Noboru</creator><creator>Nagata, Masahiko</creator><creator>Kuwabara, Masachika</creator><creator>Yokota, Naoto</creator><creator>Eto, Takuma</creator><creator>Kuroki, Munetoshi</creator><creator>Shimada, Kazuyuki</creator><creator>Kario, Kazuomi</creator><general>Wolters Kluwer Health | Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201402</creationdate><title>Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients</title><author>Yano, Yuichiro ; Bakris, George L ; Inokuchi, Takashi ; Ohba, Yusuke ; Tamaki, Noboru ; Nagata, Masahiko ; Kuwabara, Masachika ; Yokota, Naoto ; Eto, Takuma ; Kuroki, Munetoshi ; Shimada, Kazuyuki ; Kario, Kazuomi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3565-7650b4cd3d661e159b79998efcbda794f25b81bb1fa24b0075c23c13d77177e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Pressure</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Cardiovascular Diseases - physiopathology</topic><topic>Cardiovascular Diseases - psychology</topic><topic>Cognition Disorders - complications</topic><topic>Cognition Disorders - psychology</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Hypertension - physiopathology</topic><topic>Hypertension - psychology</topic><topic>Male</topic><topic>Mental Status Schedule</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Risk Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yano, Yuichiro</creatorcontrib><creatorcontrib>Bakris, George L</creatorcontrib><creatorcontrib>Inokuchi, Takashi</creatorcontrib><creatorcontrib>Ohba, Yusuke</creatorcontrib><creatorcontrib>Tamaki, Noboru</creatorcontrib><creatorcontrib>Nagata, Masahiko</creatorcontrib><creatorcontrib>Kuwabara, Masachika</creatorcontrib><creatorcontrib>Yokota, Naoto</creatorcontrib><creatorcontrib>Eto, Takuma</creatorcontrib><creatorcontrib>Kuroki, Munetoshi</creatorcontrib><creatorcontrib>Shimada, Kazuyuki</creatorcontrib><creatorcontrib>Kario, Kazuomi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hypertension</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yano, Yuichiro</au><au>Bakris, George L</au><au>Inokuchi, Takashi</au><au>Ohba, Yusuke</au><au>Tamaki, Noboru</au><au>Nagata, Masahiko</au><au>Kuwabara, Masachika</au><au>Yokota, Naoto</au><au>Eto, Takuma</au><au>Kuroki, Munetoshi</au><au>Shimada, Kazuyuki</au><au>Kario, Kazuomi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients</atitle><jtitle>Journal of hypertension</jtitle><addtitle>J Hypertens</addtitle><date>2014-02</date><risdate>2014</risdate><volume>32</volume><issue>2</issue><spage>423</spage><epage>431</epage><pages>423-431</pages><issn>0263-6352</issn><eissn>1473-5598</eissn><abstract>OBJECTIVES:This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients.
METHODS:We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points).
RESULTS:CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima–media thickness (IMT)], hazard ratio 2.5–2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction.
CONCLUSION:Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.</abstract><cop>England</cop><pub>Wolters Kluwer Health | Lippincott Williams & Wilkins</pub><pmid>24351802</pmid><doi>10.1097/HJH.0000000000000025</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Blood Pressure Cardiovascular Diseases - etiology Cardiovascular Diseases - physiopathology Cardiovascular Diseases - psychology Cognition Disorders - complications Cognition Disorders - psychology Cohort Studies Female Follow-Up Studies Humans Hypertension - complications Hypertension - physiopathology Hypertension - psychology Male Mental Status Schedule Middle Aged Prognosis Proportional Hazards Models Risk Factors |
| title | Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients |
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