Abstract 17102: Cognitive Function and Masked Hypertension in Older Hypertensive Patients
Background: Masked hypertension, defined as a normal blood pressure (BP) at the office/clinic but a higher BP outside, is associated with a high risk of cardiovascular events, but knowledge of the clinical characteristics is limited. In particular, whether the measurement of cognitive function is useful for identifying masked hypertension in older hypertensive patients remains uncertain.
Methods: We enrolled 587 older hypertensive patients (mean age: 72 years; 52% were men; 79% had been treated with antihypertensive medications). All patients were ambulatory, lived independently, and were without clinically diagnosed dementia. Cognitive function was assessed by the mini-mental state examination (MMSE). The lowest quartile of the MMSE score distribution was defined as cognitive dysfunction (n=183:mean MMSE score: 24 points).
Results: The proportion of well-controlled BP cases (office BP [OBP] <140/90 mmHg and 24-hour BP<130/80 mmHg), white-coat hypertension (OBP>140/90 mmHg and 24-hour BP<130/80 mmHg), masked hypertension (OBP<140/90 mmHg and 24-hour BP> 130/80 mmHg), and sustained hypertension (OBP> 140/90 mmHg and 24-hour BP> 130/80 mmHg) were 16.3%, 21.7%, 15.8%, and 46.3%, respectively. The estimated mean (95% confidence interval [CI]) scores of MMSE, adjusted for age, sex, and education, were as follows:27.0 (26.4-27.5) points in well-controlled BP cases, 26.8 (26.4-27.2) points in white coat hypertension, 25.9 (25.3-26.5) points in masked hypertension, and 26.1 (25.8-26.4) points in sustained hypertension (trend P=0.003).
In multiple regression models (n=587), cognitive dysfunction was associated with the existence of masked hypertension (odds ratio:2.4; 95% CI:1.1-5.0), independent of age, sex, educational attainment, current smoking, daily drinking, use of antihypertensive medications, BMI, diabetes, use of statins, and pre-existing cardiovascular disease (CVD).
Conclusion: The observed independent association between cognitive dysfunction and masked hypertension suggests that a cognitive function test may be useful for identifying older hypertensive patients who are at risk for high BP outside the office.
Author Disclosures: M. Hayakawa: None. Y. Yano: None. K. Shimada: None. K. Kario: None.
- © 2014 by American Heart Association, Inc.