Abstract 17759: Cognitive Dysfunction, Rather Than Sleep Blood Pressure Values, is an Independent Predictor of Cardiovascular Disease in Treated Older Hypertensive Patients
Backgrounds: Cognitive dysfunction has been shown to be an independent predictor of cardiovascular disease (CVD). Cognitive dysfunction is closely associated with high sleep blood pressure (BP) levels, and sleep BP level has also been shown to have the greatest prognostic accuracy among subtypes of BP measurements. Therefore, our aims are to assess whether the predictive values of cognitive dysfunction is independently of sleep BP levels in older hypertensive patients.
Methods:In this prospective observational study, 470 treated older hypertensive patients(mean, 73.7 years; 42.0% men) were enrolled. We evaluated 24-hour BP levels, mini-mental state examination (MMSE), and carotid artery intima-media thickness (IMT) at baseline. The incidences of CVD, including coronary artery disease, stroke, congestive heart failure, and sudden death were prospectively ascertained.
Results: During an average (standard deviation) duration of 2.8 (0.7) years (1323 person-years), there were 36 CVD events (coronary artery disease: 8; stroke: 15; congestive heart failure: 9; and sudden death: 4). Patients with CVD events had higher levels of mean sleep BP (130 vs. 122 mmHg) and median internal-carotid artery IMT (1.35 vs. 1.13 mm), and lower levels of median MMSE score (25 vs. 27 points; all P<0.05) at baseline than those without CVD events. Cox regression analyses, adjusted by significant covariates, revealed that both a 1SD decrease in the MMSE score (- 3 points) and a 1SD increase in internal-carotid artery IMT (+ 0.43 mm), but not with a 1SD increase in sleep BP (+18mmHg), was independently associated with an increased risk of CVD events (hazard ratio [95% confidence interval]:1.39 [1.03-1.89]) and 1.50 [1.12-2.03], respectively (both P<0.05).
Conclusions: In treated older hypertensive patients, cognitive dysfunction is a useful predictor of CVD events, and this association is independent of nocturnal BP levels as well as the extent of carotid IMT.
- © 2012 by American Heart Association, Inc.