Сеченовский вестник (Nov 2020)
Vascular markers of cognitive dysfunction in patients with uncontrolled arterial hypertension
Abstract
The presence of arterial hypertension (AH) leads to the development of cognitive dysfunction, in the genesis of which a significant role is assigned to vascular factors. Aim. To study the state of cognitive function and associated vascular factors in patients with uncontrolled AH. Materials and methods. The research involved 88 patients with uncontrolled AH (UAH) — group 1 (median age 60, men — 39%) and 46 patients with controlled AH (CAH) — group 2 (median age 59, men — 41%). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). There were studied vascular factors: thickness of the intima-media complex (IMC), pulse wave velocity (PWV), microcirculation flow index (MFI) and asymmetric dimethylarginine (ADMA) concentrations. For the statistical analysis the following criteria were used: Student t-test, Mann—Whitney test. Multifactorial linear regression analysis was performed in groups. Results. In Group 1, there was a lower cognitive function index by MoCA — 24 [22; 26] points against 26 [25; 27] points in Group 2 (p = 0.002). IMC thickness was higher in Group 1 than in Group 2 (1.1 [0.90; 1.20] mm vs 1.0 [0.80; 1.10] mm, p = 0.042), concentration of ADMA was higher in Group 1 (0.73 ± 0.21 µmol/l vs 0.65 ± 0.1 µmol/l, p = 0.02), MFI was higher in Group 2 (30.6 [27.1; 34.4] perf. units vs. 22.8 [18.6; 26.1] perf. units, р < 0.001). No differences between the groups were found in PWV. In regression analysis, the following factors had a statistically significant effect on MoCA scores: in Group 1 — age, IMC thickness, ADMA and MFI; in Group 2 — age and glomerular filtrate rate. Conclusion. Patients with uncontrolled AH have more pronounced cognitive dysfunction than those with controlled AH, which is associated with increased IMC thickness, impaired microcirculation and increased ADMA concentration.
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