‘Window for intervention’ to forestall hypertensive cognitive decline

Dec 16 2013

By Sara Freeman, medwireNews Reporter

Newly diagnosed hypertension is predictive of cognitive decline in middle-aged individuals and is worse in those with poorly controlled blood pressure, Dutch researchers have found.

The findings add to observational data showing that hypertension is not only associated with accelerated cognitive decline and dementia, but also that cognitive decline is worse if hypertension is left untreated or not adequately controlled using antihypertensive medications.

However, the researchers say the cognitive declines were “insidious,” with the effect on executive function apparent only from around 6 years after hypertension onset “possibly opening a window for early intervention.”

As part of the Maastricht Aging Study (MAAS), a prospective study on brain aging, Sebastian Köhler (Maastricht University, the Netherlands) and colleagues looked at the temporal evolution of cognitive changes in relation to hypertension in individuals aged from 25 to 84 years at baseline at 6 and 12 years’ follow-up.

Just over one-third (35.3%) of 1805 study participants were hypertensive at baseline and 352 (30.2%) were diagnosed with hypertension during the follow-up period.

“Baseline hypertension went together with a faster decline in all cognitive domains,” Köhler et al write in Hypertension. “There was a steady decline in memory and information processing speed, whereas the effect on executive functions showed a time-lagged drop from 6–12-year follow-up only.”

Women with baseline hypertension showed a faster decline than men in cognitive function from baseline to the 12-year follow-up point; otherwise results were similar for both men and women. Baseline hypertension also predicted faster decline in memory, executive functioning, and information processing speed in individuals younger than 65 years, but was only predictive of information processing decline in older people.

Compared with normotensive individuals, those with untreated baseline hypertension had faster declines in memory and information processing speed, and those with treated but poorly controlled baseline hypertension showed declines in both of these categories and also in executive function. Meanwhile, those with controlled baseline hypertension exhibited declines in executive function only.

Participants with incident hypertension had faster declines in memory and information processing speed but not executive functions versus normotensive participants. Cognitive decline was faster in those younger than 65 years than in older participants and worse in those with untreated or uncontrolled hypertension.

“[O]ur findings imply that cognitive decline could be prevented by timely [blood pressure] management,” conclude Köhler et al. “Results may support treatment adherence in patients with newly diagnosed hypertension by showing the importance of [blood pressure] control for brain functioning.”

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