The Relationship Between Parameters Of Ambulatory Blood Pressure Monitoring And Cognitive Impairment In Elderly Hypertensive Patients

ObjectivesTo investigate the cognition and blood pressure status, to explore the relationship between parameters of blood pressure variation and circadian rhythms in ambulatory blood pressure monitoring and cognitive impairment in eldly hypertensive patients.MethodsFrom April 2014 to February 2015, 346 primary hypertension patients and 72 control patients were selected from Fujian provincial hospital, finished the basic data collection, physical examination, ambulatory blood pressure monitoring, mini-mental state examination(MMSE) and montreal cognitive assessment(Mo CA). Orderly logistic regression analysis was applied to explore the influence of different blood pressure parameters on cognitive function.Results1. The total score of MMSE and MoCA were 27.7±2.4 and 24.5±3.6 in hypertension group, those were 28.7±1.4 and 25.9±3.1 in control group. Compared with control group,hypertension group had lower total score of cognition, orientational ability, computing ability, linguistic competence, spatial and executive capacity, abstract ability and delayed memory, the differences were significant(all P<0.05). 2. The morbidity of cognitive impairment in hypertensive patients was 1.5% using MMSE, that was 54.6% using Mo CA. The score of cognition was significantly different in groups separated by gender and degree of education(all P<0.05). There was no statisical difference in groups with diabetes disease or not.(all P>0.05). 3. The declined rate of nocturnal systolic blood pressure and diastolic blood standard deviation had significantly difference in different age cohorts(all P<0.05). In different groups of gender and diabetes disease, the difference between the two groups was non-significant(P>0.05). 4. In elderly hypertensive patients, antihypertensive drugs integral, nocturnal systolic blood pressure in cognitive impairment group were higher than normal group. The declined rate of systolic, diastolic and mean blood pressure were lower in cognitive impairment group(all P<0.05). There was no statistic significance between two groups in weighted standard deviation of systolic blood pressure(SBPw SD) and diastolic blood pressure(DBPw SD), average blood pressure variability of systolic blood pressure(SBPARV) and diastolic blood pressure(DBPARV). 5. The partial correlation analysis revealed negative correlation between nocturnal systolic blood pressure and delayed memory(r=﹣0.201, P<0.05); the positive relationship was found in declined rate of systolic blood pressure, DBPw SD and linguistic competence(r=0.247, 0.176, all P<0.05), also in declined rate of diastolic blood pressure and abstract ability(r=0.219, P<0.05); the correlation of linguistic competence, abstract ability and declined rate of mean blood were positive(r = 0.191, 0.188, all P<0.05). 6. Orderly logistic regression analysis confirmed that, the lower declined rate of nocturnal systolic blood pressure brought greater risk of linguistic competence impairment(OR=3.983, 95%CI: 1.611~9.845). The lower declined rate of diastolic blood pressure lead to higher risk of abstract ability impairment(OR=2.282, 95%CI: 1.024~5.641). The nocturnal systolic blood pressure higher, the risk of impaired delayed memory were greater(OR=2.457, 95%CI: 1.102~5.485).ConclusionsThe patients with hypertension had worse cognitive function compared with non-hypertensive patients. There was seldom correlation between blood pressure variation and cognitive function. The circadian rhythm of blood pressure has influence on cognitive function. The control of this might slow down the cognitive decline.