Study On The Correlation Between Relative Ventricular Wall Thickness And Cognitive Dysfunction And Distribution Of TCM Syndrome Types In Patients With Hypertensio

Hypertension is a common chronic disease in the middle-aged and elderly,and it is an important risk factor for cardiovascular disease.It is easy to cause multiple organ damage.Left ventricular hypertrophy(LVH)is a typical manifestation of cardiac involvement.Studies have shown that hypertension is independently related to cognitive impairment(CI),which can cause damage to many functions such as brain memory,and even lose the ability to take care of themselves,bringing a heavy burden to the family and society.According to traditional Chinese medicine,"the heart governs the blood" and "the mind governs the spirit".The heart can not only regulate the operation of the whole body blood,but also play a strong role in regulating mental activities such as the state of consciousness.In recent years,clinical studies have found that changes in cardiac structure and function have a certain impact on cognitive function,but there are still few studies on the relationship between cardiac structure and cognitive function,especially in people with hypertension.The correlation between them has not been fully confirmed.Relative ventricular wall thickness(RWT)can reflect the degree of myocardial hypertrophy and the changes of left ventricular geometry,so this study focuses on the relationship between relative ventricular wall thickness and cognitive function and the distribution of TCM syndrome types in middle-aged and elderly patients with hypertension.Objective:1 In this study,middle-aged and elderly patients with hypertension were selected as subjects.The cardiac structure and function were detected by echocardiography,and the cognitive function was evaluated by mini-mental state examination(MMSE)and Montreal cognitive assessment scale(MoCA),so as to explore the relationship between RWT and cognitive impairment.2 To explore the distribution of TCM syndrome types in middle-aged and elderly patients with hypertension complicated with cognitive impairment,and to compare the similarities and differences of TCM syndrome types between middle-aged and elderly patients with normal cognitive function and patients with abnormal RWT.Methods:According to the standard of nano-excretion,45-80-year-old hypertensive patients who were admitted to the outpatient department of cardiology and cardiology ward of Dongzhimen Hospital of Beijing University of traditional Chinese Medicine from February 2022 to March 2023 were collected to evaluate their cognitive function.According to MoCA evaluation,the patients with total score≥26 were classified as normal cognitive function group,and those with total score less than 26 as cognitive impairment group.Collect the basic information of patients,blood routine,blood lipids,blood sugar and other general clinical data,examine the patients by echocardiography,record the information of the four diagnoses of traditional Chinese medicine,and judge the syndrome types of traditional Chinese medicine according to the scale of TCM Syndromes of Hypertension.Results:1 General clinical data:there were 72 patients with normal cognitive function in this study,including 39 males and 33 females,78 patients with cognitive impairment,50 females and 28 males.There was significant difference in gender distribution between the two groups(P<0.05).Compared with males,the proportion of cognitive impairment in female patients with hypertension was higher.The patients with cognitive impairment had higher age and lower level of education than those with normal cognitive function,and there were differences in age and years of education between the two groups(P<0.001).In terms of weight-related indexes,the waist circumference-height ratio of patients with cognitive impairment was larger,and the difference was statistically significant(P<0.01).In terms of the prevalence of hypertension,there was significant difference in the course and grade of hypertension between the two groups(P<0.05).The patients with poor cognitive function had longer course of hypertension and higher blood pressure grade.there was no significant difference in risk stratification between the two groups(P>0.05).In terms of basic diseases,the proportion of CI was higher in patients with lacunar infarction(P<0.05).2 Blood lipids and cognitive function:there was no significant difference in blood lipid related indexes of TG,TC,HDL-C,LDL-C,Non-HDL-C and RC between the normal cognitive function group and the cognitive impairment group.3 HCY,HbA1C and cognition:there were differences in the levels of HCY and glycosylated hemoglobin between the two groups.The levels of HCY and HbA1C in the cognitive impairment group were higher than those in the normal cognitive function group.4 Echocardiographic indexes and cognition:in terms of left ventricular structure,there were significant differences in IVST and LVPWT between the two groups,and the IVST and LVPWT in the cognitive impairment group were significantly higher than those in the normal cognitive function group(P<0.001).There was no significant difference in the levels of LVEDD and LVM between the two groups.There was significant difference in the distribution of RWT thickening between the two groups,and the proportion of RWT thickening was higher in patients with cognitive impairment.In terms of left ventricular function,LVEF in patients with normal cognitive function was higher than that in patients with cognitive impairment(P<0.001),and there was significant difference between the two groups(P<0.05).Compared with patients with normal cognitive function,patients with cognitive impairment had higher Emax and worse diastolic function.5 Logistic regression analysis of CI related factors in patients with hypertension:after including age,sex,years of education,HCY and other statistically significant factors in the analysis of differences in multivariate regression,it was found that the number of years of education had a statistically significant effect on the cognition of middle-aged and elderly patients with hypertension(OR=0.829,95%CI 0.712-0.966,P<0.05).The higher the level of education,the lower the risk of CI in middle-aged and elderly patients with hypertension.Compared with patients with normal RWT,middle-aged and elderly hypertensive patients with thickened RWT had a higher risk of cognitive impairment,and the difference was statistically significant(OR=5.560,95%CI 2.134-14.489,P<0.001).The effect of LVMI level on CI in middle-aged and elderly hypertensive patients was statistically significant,and the increase of LVMI would increase the risk of cognitive impairment in these patients(OR=1.031,95%CI 1.008-1.056,P<0.001).6 The effect of RWT thickening on cognitive function:there was difference in MoCA score between normal RWT group and RWT thickening group.The MoCA score of patients with RWT thickening was lower,but there was no significant difference in MMSE total score.There were differences between the two groups in the scores of cognitive function in all aspects of MoCA(P<0.001).The patients with thickened RWT had lower memory scores,but there was no significant difference in visual space/executive function,naming ability,attention,language ability,abstract ability and orientation ability between the two groups(P>0.001).7 Left ventricular configuration and cognition:there were significant differences in the distribution of four kinds of ventricular configuration between normal cognitive function group and cognitive impairment group(P<0.01).Compared with normal ventricular configuration,CR and CH were significantly correlated with cognitive dysfunction,but the correlation was still significant after adjusting confounding factors.CR will increase the risk of cognitive impairment in patients with hypertension(OR=5.610,95%CI 1.810-17.384,P<0.01),and CH is more likely to develop cognitive impairment than normal ventricular configuration(OR=6.853,95%CI 1.837-25.574,P<0.01).8 Distribution characteristics of TCM syndrome types:the distribution of TCM syndrome types in the cognitive impairment group was as follows:phlegm-dampness syndrome>yin deficiency and yang hyperactivity syndrome>blood stasis syndrome>yin-yang deficiency syndrome>liver-fire hyperactivity syndrome.The distribution of TCM syndrome types of patients with normal cognitive function was more uniform.There was significant difference in the distribution of phlegm-dampness syndrome between the two groups(P<0.05).The TCM syndrome type of patients with thickening of RWT was mainly phlegm-dampness type,and that of patients with normal RWT was mainly blood stasis blocking collaterals type.There was no significant difference in the proportion of the other three syndrome types.There was significant difference in the distribution of phlegm-dampness syndrome between the two groups.Conclusion:1 The cognitive function of middle-aged and elderly patients with hypertension is correlated with years of education,RWT and LVMI.Thickening of RWT is an important risk factor for cognitive impairment in patients with hypertension,and thickening of RWT mainly affects memory ability in cognitive function.2 The change of left ventricular configuration is related to cognitive impairment in middleaged and elderly patients with hypertension.Compared with normal ventricular configuration,patients with ventricular configuration of CR and CH have a higher risk of cognitive impairment.3 The TCM syndrome types of middle-aged and elderly hypertension patients with cognitive impairment and RWT thickening are mainly phlegm-dampness syndrome.compared with other syndrome types,hypertensive patients with phlegm-dampness have a higher risk of cognitive dysfunction and RWT thickening.