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Macdonald AS, McConnachie A, Dickie DA, Bath PM, Forbes K, Quinn T, Broomfield NM, Dani K, Doney A, Muir KW, Struthers A, Walters M, Barber M, Bhalla A, Cameron A, Guyler P, Hassan A, Kearney M, Keegan B, Lakshmanan S, Macleod MJ, Randall M, Shaw L, Subramanian G, Werring D, Dawson J. Allopurinol and blood pressure variability following ischemic stroke and transient ischemic attack: a secondary analysis of XILO-FIST. J Hum Hypertens 2024; 38:307-313. [PMID: 38438602 PMCID: PMC11001576 DOI: 10.1038/s41371-024-00906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
Blood Pressure Variability (BPV) is associated with cardiovascular risk and serum uric acid level. We investigated whether BPV was lowered by allopurinol and whether it was related to neuroimaging markers of cerebral small vessel disease (CSVD) and cognition. We used data from a randomised, double-blind, placebo-controlled trial of two years allopurinol treatment after recent ischemic stroke or transient ischemic attack. Visit-to-visit BPV was assessed using brachial blood pressure (BP) recordings. Short-term BPV was assessed using ambulatory BP monitoring (ABPM) performed at 4 weeks and 2 years. Brain MRI was performed at baseline and 2 years. BPV measures were compared between the allopurinol and placebo groups, and with CSVD and cognition. 409 participants (205 allopurinol; 204 placebo) were included in the visit-to-visit BPV analyses. There were no significant differences found between placebo and allopurinol groups for any measure of visit-to-visit BPV. 196 participants were included in analyses of short-term BPV at week 4. Two measures were reduced by allopurinol: the standard deviation (SD) of systolic BP (by 1.30 mmHg (95% confidence interval (CI) 0.18-2.42, p = 0.023)); and the average real variability (ARV) of systolic BP (by 1.31 mmHg (95% CI 0.31-2.32, p = 0.011)). There were no differences in other measures at week 4 or in any measure at 2 years, and BPV was not associated with CSVD or cognition. Allopurinol treatment did not affect visit-to-visit BPV in people with recent ischemic stroke or TIA. Two BPV measures were reduced at week 4 by allopurinol but not at 2 years.
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Affiliation(s)
- Alexander S Macdonald
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - David Alexander Dickie
- DD Analytics Cubed Ltd, 73 Union Street, Greenock, Scotland, PA16 8BG, UK
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Kirsten Forbes
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Terence Quinn
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Niall M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Krishna Dani
- Department of Neurology, Institute of Neurological Sciences Glasgow, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Alex Doney
- Medicine Monitoring Unit (MEMO), School of Medicine, University of Dundee. Ninewells Hospital, Dundee, DD1 9SY, UK
- Division of Imaging and Science Technology, School of Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Keith W Muir
- School of Psychology & Neuroscience, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Allan Struthers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mark Barber
- University Department of Stroke Care, University Hospital Monklands, Airdrie, ML6 OJS, UK
| | - Ajay Bhalla
- Department of Stroke, Ageing and Health, Guy's and St Thomas NHS Foundation Trust, St Thomas' Hospital, Lambeth Palace Rd, London, SE1 7EH, UK
| | - Alan Cameron
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Paul Guyler
- Department of Stroke Medicine, Mid and South Essex University Hospitals Group, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, SS0 0RY, UK
| | - Ahamad Hassan
- Department of Neurology, Leeds General Infirmary, Leeds, UK
| | | | - Breffni Keegan
- Department of Medicine, Southwest Acute Hospital, Enniskillen, BT74 6DN, UK
| | - Sekaran Lakshmanan
- Department of Stroke Medicine, The Luton and Dunstable University Hospital, Bedfordshire, NHSFT, Lewsey Road, Luton, LU4 0DZ, UK
| | | | - Marc Randall
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Louise Shaw
- Department of Stroke Medicine, Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Ganesh Subramanian
- Department of Stroke Medicine, Nottingham University Hospitals, Nottingham, NG5 1PB, UK
| | - David Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, University College Hospitals NHS Foundation Trust, London, UK
| | - Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.
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Nizami AA, Mustafa W, Qadir M, Shahzad M, Iqbal H, Ali A, Jadoon SK, Akbar A, Tasneem S, Saleem Khan M. Risk Factors of Cardiovascular and Cerebrovascular Events in Patients With Uraemia Complicated With Hypertension During Maintenance Haemodialysis Treatment. Cureus 2024; 16:e53411. [PMID: 38435216 PMCID: PMC10908417 DOI: 10.7759/cureus.53411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION This study aimed to investigate the risk factors associated with major adverse cardiovascular (group of events that affect heart and blood vessels) and cerebrovascular (events affecting blood vessels supplying the brain) events (MACCE) in patients with uraemia complicated with hypertension who required maintenance haemodialysis (MHD) treatment. METHODOLOGY Clinical data and laboratory indicators of 156 uraemia patients complicated with hypertension were collected and retrospectively analysed. The patients were admitted to a tertiary care hospital (Abbas Institute of Medical Sciences AIMS) in Muzaffarabad, Pakistan, from February 2018 to February 2022. The data was collected through consecutive sampling and patients were recruited after following the inclusion and exclusion criteria. RESULTS Eighty-one out of 156 patients were not complicated with MACCE, and 75 patients were complicated with MACCE during the MHD treatment cycle, with an incidence of 48.08%. Compared to the non-MACCE group, the MACCE group's diabetes, body mass growth rate, triglyceride (TG), NT-proBNP, standard deviation and coefficient of variance for systolic and diastolic blood pressure (SBP-SD, SBP-CV, DBP-SD, and DBP-CV) showed significant differences (P<0.05) between the groups. Diabetes, body mass growth rate, TG, NT-proBNP, SBP-SD, SBP-CV, DBP-SD, and DBP-CV with odds ratios of 3.074, 3.202, 2.188, 2.512, 2.357, 2.431, 2.299, and 2.062 respectively were risk factors for MACCE in uraemia patients with hypertension. CONCLUSION From the results of this study, we inferred that patients with uraemia and hypertension complicated by MACCE in the treatment cycle of MHD were related to diabetes, body mass growth rate, TG, NT-proBNP, SBP-SD, SBP-CV, DBP-SD, and DBP-CV.
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Affiliation(s)
| | - Waqar Mustafa
- Cardiology, Combined Military Hospital, Muzaffarabad, PAK
| | - Mamoon Qadir
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Maria Shahzad
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Hamid Iqbal
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Anwar Ali
- Cardiology, Kulsum International Hospital, Islamabad, PAK
| | | | - Amna Akbar
- Emergency and Accident, District Headquarters Hospital, Muzaffarabad, PAK
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Ebinger JE, Driver MP, Huang TY, Magraner J, Botting PG, Wang M, Chen PS, Bello NA, Ouyang D, Theurer J, Cheng S, Tan ZS. Blood pressure variability supersedes heart rate variability as a real-world measure of dementia risk. Sci Rep 2024; 14:1838. [PMID: 38246978 PMCID: PMC10800333 DOI: 10.1038/s41598-024-52406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/18/2024] [Indexed: 01/23/2024] Open
Abstract
Blood pressure variability (BPV) and heart rate variability (HRV) have been associated with Alzheimer's Disease and Related Dementias (ADRD) in rigorously controlled studies. However, the extent to which BPV and HRV may offer predictive information in real-world, routine clinical care is unclear. In a retrospective cohort study of 48,204 adults (age 54.9 ± 17.5 years, 60% female) receiving continuous care at a single center, we derived BPV and HRV from routinely collected clinical data. We use multivariable Cox models to evaluate the association of BPV and HRV, separately and in combination, with incident ADRD. Over a median 3 [2.4, 3.0] years, there were 443 cases of new-onset ADRD. We found that clinically derived measures of BPV, but not HRV, were consistently associated with incident ADRD. In combined analyses, only patients in both the highest quartile of BPV and lowest quartile of HRV had increased ADRD risk (HR 2.34, 95% CI 1.44-3.81). These results indicate that clinically derived BPV, rather than HRV, offers a consistent and readily available metric for ADRD risk assessment in a real-world patient care setting. Thus, implementation of BPV as a widely accessible tool could allow clinical providers to efficiently identify patients most likely to benefit from comprehensive ADRD screening.
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Affiliation(s)
- Joseph E Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Matthew P Driver
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tzu Yu Huang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jose Magraner
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick G Botting
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Minhao Wang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Peng-Sheng Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Natalie A Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Ouyang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Theurer
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zaldy S Tan
- Departments of Neurology and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Iluț S, Vesa ŞC, Văcăraș V, Brăiță L, Dăscălescu VC, Fantu I, Mureșanu DF. Biological Risk Factors Influencing Vascular Cognitive Impairments: A Review of the Evidence. Brain Sci 2023; 13:1094. [PMID: 37509024 PMCID: PMC10377134 DOI: 10.3390/brainsci13071094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Vascular cognitive impairment encompasses several types of deficits, ranging from mild cognitive impairment to dementia. Cognitive reserve refers to the brain's ability to balance damage and improve performance through certain types of brain networks. The purpose of this review was to assess the relationship between reserve in vascular impairment, specifically looking at whether cognitive impairment is influenced by cognitive reserve, identifying significant vascular risk factors and their pathological pathways. To achieve this purpose, a review covering these issues was conducted within the Embase, Cochrane, and PubMed database. A total of 657 scientific articles were found, and 33 papers were considered for the final analysis. We concluded that there is no consensus on the protective effects of brain reserve on cognitive impairment. Stroke and diabetes can be considered significant risk factors for vascular cognitive impairment, while hypertension is not as damaging as blood pressure variability, which structurally alters the brain through a variety of mechanisms.
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Affiliation(s)
- Silvina Iluț
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania; (S.I.); (V.V.); (L.B.); (V.-C.D.); (I.F.); (D.-F.M.)
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
| | - Ştefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Haţieganu” University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Vitalie Văcăraș
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania; (S.I.); (V.V.); (L.B.); (V.-C.D.); (I.F.); (D.-F.M.)
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
| | - Lavinia Brăiță
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania; (S.I.); (V.V.); (L.B.); (V.-C.D.); (I.F.); (D.-F.M.)
| | - Vlad-Constantin Dăscălescu
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania; (S.I.); (V.V.); (L.B.); (V.-C.D.); (I.F.); (D.-F.M.)
| | - Ioana Fantu
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania; (S.I.); (V.V.); (L.B.); (V.-C.D.); (I.F.); (D.-F.M.)
| | - Dafin-Fior Mureșanu
- Department of Neurosciences, “Iuliu Haţieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania; (S.I.); (V.V.); (L.B.); (V.-C.D.); (I.F.); (D.-F.M.)
- Clinical Rehabilitation Hospital, 46-50 Viilor Street, 400347 Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, 37 Mircea Eliade Street, 400364 Cluj-Napoca, Romania
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Sun F. The impact of blood pressure variability on cognition: current limitations and new advances. J Hypertens 2023; 41:888-905. [PMID: 37016905 PMCID: PMC10158606 DOI: 10.1097/hjh.0000000000003422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 04/06/2023]
Abstract
Dementia is the most common neurodegenerative disease in the aging population. Emerging evidence indicates that blood pressure (BP) variability is correlated with cognitive impairment and dementia independent of mean BP levels. The state-of-the-art review summarizes the latest evidence regarding the impact of BP variability on cognition in cognitively intact populations, patients with mild cognitive impairment, and different dementia types, focusing on the important confounding factors and new advances. This review also summarizes the potential mechanisms underlying the relationship between BP variability and cognitive impairment, and dementia, briefly discussing sex differences in the relationship. At last, current limitations and future perspectives are discussed to optimize BP management in preventing cognitive impairment and dementia.
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Affiliation(s)
- Fen Sun
- Department of Anatomy, College of Basic Medicine
- Key Laboratory of Organ Development and Regeneration of Zhejiang Province, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Ebinger JE, Driver MP, Botting P, Wang M, Cheng S, Tan ZS. Association of blood pressure variability during acute care hospitalization and incident dementia. Front Neurol 2023; 14:1085885. [PMID: 36824417 PMCID: PMC9941567 DOI: 10.3389/fneur.2023.1085885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Background and objectives Recognized as a potential risk factor for Alzheimer's disease and related dementias (ADRD), blood pressure variability (BPV) could be leveraged to facilitate identification of at-risk individuals at a population level. Granular BPV data are available during acute care hospitalization periods for potentially high-risk patients, but the incident ADRD risk association with BPV measured in this setting is unknown. Our objective was to evaluate the relation of BPV, measured during acute care hospitalization, and incidence of ADRD. Methods We retrospectively studied adults, without a prior ADRD diagnosis, who were admitted to a large quaternary care medical center in Southern California between January 1, 2013 and December 31, 2019. For all patients, determined BPV, calculated as variability independent of the mean (VIM), using blood pressure readings obtained as part of routine clinical care. We used multivariable Cox proportional hazards regression to examine the association between BP VIM during hospitalization and the development of incident dementia, determined by new ICD-9/10 coding or the new prescription of dementia medication, occurring at least 2 years after the index hospitalization. Results Of 81,892 adults hospitalized without a prior ADRD diagnosis, 2,442 (2.98%) went on to develop ADRD (2.6 to 5.2 years after hospitalization). In multivariable-adjusted Cox models, both systolic (HR 1.05, 95% CI 1.00-1.09) and diastolic (1.06, 1.02-1.10) VIM were associated with incident ADRD. In pre-specified stratified analyses, the VIM associations with incident ADRD were most pronounced in individuals over age 60 years and among those with renal disease or hypertension. Results were similar when repeated to include incident ADRD diagnoses made at least 1 or 3 years after index hospitalization. Discussion We found that measurements of BPV from acute care hospitalizations can be used to identify individuals at risk for developing a diagnosis of ADRD within approximately 5 years. Use of the readily accessible BPV measure may allow healthcare systems to risk stratify patients during periods of intense patient-provider interaction and, in turn, facilitate engagement in ADRD screening programs.
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Affiliation(s)
- Joseph E. Ebinger
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States,*Correspondence: Joseph E. Ebinger ✉
| | - Matthew P. Driver
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Patrick Botting
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Minhao Wang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Zaldy S. Tan
- Department of Neurology and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States,David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Waziry R, Claus JJ, Hofman A. Dementia Risk Following Ischemic Stroke: A Systematic Review and Meta-Analysis of Factors Collected at Time of Stroke Diagnosis. J Alzheimers Dis 2022; 90:1535-1546. [PMID: 36278345 DOI: 10.3233/jad-220317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The majority of stroke cases are ischemic in origin and ischemic stroke survivors represent a high-risk population for progression to dementia. OBJECTIVE To determine incidence rates and predictors of dementia after ischemic stroke. METHODS A systematic review and meta-analysis compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). RESULTS 5,843 studies were screened for title and abstract. 292 eligible studies were screened for full text. A total of 22 studies met the inclusion criteria and were included, representing 55,929 ischemic stroke survivors. Cumulative incidence of dementia after stroke was 20% at 5 years, 30% at 15 years, and 48% at 25 years of follow-up. Dementia incidence rates were 1.5 times higher among patients with recurrent ischemic stroke compared to patients with first-time stroke. Predictors of dementia after ischemic stroke included female gender (OR 1.2, 95% CI (1.1, 1.4)), hypertension (1.4, (1.1, 2.0)), diabetes mellitus (1.6, (1.3, 2.1)), atrial fibrillation (1.9, (1.2, 3.0)), previous stroke (2.0, (1.6, 2.6)), presence of stroke lesion in dominant hemisphere (2.4, (1.3, 4.5)), brain stem or cerebellum (OR 0.5, (0.3, 0.9)) or frontal lobe (3.7, (1.2, 12.0)), presence of aphasia (OR 7.9, (2.4, 26.0)), dysphasia (5.8, (3.0, 11.3)), gait impairment (1.7, (1.1, 2.7)), presence of white matter hyperintensities (3.2, (2.0, 5.3)), and medial temporal lobe atrophy (3.9, (1.9, 8.3)). CONCLUSION Factors routinely collected for stroke patients are a useful resource for monitoring dementia progression in this population. In the present meta-analysis, cardiovascular factors, stroke location, stroke-related disability and chronic brain changes were predictors of dementia after ischemic stroke.
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Affiliation(s)
- Reem Waziry
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jacqueline J Claus
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Camafort M, Chung WJ, Shin JH. Role of ambulatory blood pressure monitoring in elderly hypertensive patients. Clin Hypertens 2022; 28:22. [PMID: 35773739 PMCID: PMC9248111 DOI: 10.1186/s40885-022-00205-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/10/2022] [Indexed: 01/02/2023] Open
Abstract
Background Arterial hypertension is facing some changes in the last years. Its prevalence is increasing in elderly subjects. This growing prevalence is due to longer survival of the population worldwide, among other factors. On the other hand, recent guidelines have insisted in the relevance of out of office blood pressure measurements, to improve diagnostic and management of hypertension. Therefore, elderly subjects with hypertension could benefit from out of office blood pressure measurements, like ambulatory blood pressure measurements; nevertheless, there are very few or no specific recommendations regarding this. Aim In this review, we will gather the most important information about this subject. Results As hypertension in the elderly has some specific characteristics related to aging of the cardiovascular system, the most important aspect could be that these characteristics make ambulatory blood pressure measurement suitable for its use in elderly. Among those a higher prevalence of white coat hypertension, white coat phenomenon, and a higher nocturnal blood pressure and higher prevalence of nondipper and riser pattern, represent aspects that should be considered for better diagnostic and an improved management. Conclusion As the prevalence of hypertension will grow in the next years, more studies specifically directed to this subject are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00205-6.
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Affiliation(s)
- Miguel Camafort
- ESH Excellence Hypertension Center, Department of Internal Medicine, Geriatrics Section, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Research Group on Cardiovascular Risk, Nutrition and Aging, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Research Group CB06/03/0019, Biomedical Network Research Center in Obesity and Nutrition (CIBER-OBN), Institute of Health Carlos III (ISCIII), Ministry of Science, Innovation and Universities, Madrid, Spain.
| | - Wook-Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.,Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Lattanzi S, Divani AA, Brigo F. When cognitive impairment has a vascular origin. J Clin Hypertens (Greenwich) 2022; 24:858-860. [PMID: 35244333 PMCID: PMC9278576 DOI: 10.1111/jch.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Afshin A Divani
- Department of Neurology, University of New Mexico, New Mexico, USA
| | - Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano (BZ), Italy
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Pallangyo P, Mkojera ZS, Komba M, Mgopa LR, Bhalia S, Mayala H, Wibonela S, Misidai N, Swai HJ, Millinga J, Chavala E, Kisenge PR, Janabi M. Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study. BMC Neurol 2021; 21:433. [PMID: 34749692 PMCID: PMC8573988 DOI: 10.1186/s12883-021-02467-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. METHODOLOGY A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p < 0.05 was used to denote a statistical significance. RESULTS A total of 1201 hypertensive patients were enrolled in this study. The mean age was 58.1 years and females constituted nearly two-thirds of the study population. About three quarters had excess body weight, 16.6% had diabetes, 7.7% had history of stroke, 5.7% had heart failure, 16.7% had renal dysfunction, 53.7% had anemia, 27.7% had hypertriglyceridemia, 38.5% had elevated LDL, and 2.4% were HIV-infected. Nearly two-thirds of participants had uncontrolled blood pressure and 8.7% had orthostatic hypotension. Overall, 524 (43.6%) of participants had cognitive impairment. During bivariate analysis in a logistic regression model of 16 characteristics, 14 parameters showed association with cognitive functions. However, after controlling for confounders, multivariate analysis revealed ≤primary education (OR 3.5, 95%CI 2.4-5.2, p < 0.001), unemployed state (OR 1.7, 95%CI 1.2-2.6, p < 0.01), rural habitation (OR 1.8, 95%CI 1.1-2.9, p = 0.01) and renal dysfunction (OR 1.7, 95%CI 1.0-2.7, p = 0.04) to have independent association with cognitive impairment. CONCLUSION This present study underscore that cognitive decline is considerably prevalent among individuals with systemic hypertension. In view of this, it is pivotal to incorporate cognitive assessment in routine evaluation of hypertensive patients.
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Affiliation(s)
- Pedro Pallangyo
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | | | - Makrina Komba
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Henry Mayala
- Directorate of Clinical Support Services, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Salma Wibonela
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
| | | | - Jalack Millinga
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Ester Chavala
- PédPäl Research Initiative, P.O Box 65066, Dar es Salaam, Tanzania
- Directorate of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Peter R. Kisenge
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Directorate of Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Jia P, Lee HWY, Chan JYC, Yiu KKL, Tsoi KKF. Long-Term Blood Pressure Variability Increases Risks of Dementia and Cognitive Decline: A Meta-Analysis of Longitudinal Studies. Hypertension 2021; 78:996-1004. [PMID: 34397274 DOI: 10.1161/hypertensionaha.121.17788] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pingping Jia
- JC School of Public Health and Primary Care (P.J., H.W.Y.L., K.K.F.T.), The Chinese University of Hong Kong
| | - Helen W Y Lee
- JC School of Public Health and Primary Care (P.J., H.W.Y.L., K.K.F.T.), The Chinese University of Hong Kong
| | - Joyce Y C Chan
- Department of Medicine and Therapeutics, Faculty of Medicine (J.Y.C.C.), The Chinese University of Hong Kong
| | - Karen K L Yiu
- Stanley Ho Big Data Decision Analytics Research Centre (K.K.L.Y., K.K.F.T.), The Chinese University of Hong Kong
| | - Kelvin K F Tsoi
- JC School of Public Health and Primary Care (P.J., H.W.Y.L., K.K.F.T.), The Chinese University of Hong Kong.,Stanley Ho Big Data Decision Analytics Research Centre (K.K.L.Y., K.K.F.T.), The Chinese University of Hong Kong
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Lee KP, Chang AYW, Sung PS. Association between Blood Pressure, Blood Pressure Variability, and Post-Stroke Cognitive Impairment. Biomedicines 2021; 9:773. [PMID: 34356837 PMCID: PMC8301473 DOI: 10.3390/biomedicines9070773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
After stroke, dynamic changes take place from necrotic-apoptotic continuum, inflammatory response to poststroke neurogenesis, and remodeling of the network. These changes and baseline brain pathology such as small vessel disease (SVD) and amyloid burden may be associated with the occurrence of early or late poststroke cognitive impairment (PSCI) or dementia (PSD), which affect not only stroke victims but also their families and even society. We reviewed the current concepts and understanding of the pathophysiology for PSCI/PSD and identified useful tools for the diagnosis and the prediction of PSCI in serological, CSF, and image characteristics. Then, we untangled their relationships with blood pressure (BP) and blood pressure variability (BPV), important but often overlooked risk factors for PSCI/PSD. Finally, we provided evidence for the modifying effects of BP and BPV on PSCI as well as pharmacological and non-pharmacological interventions and life style modification for PSCI/PSD prevention and treatment.
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Affiliation(s)
- Kang-Po Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Neurology, E-DA Hospital, Kaohsiung 824, Taiwan
| | - Alice Y. W. Chang
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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Chiu TJ, Yeh JT, Huang CJ, Chiang CE, Sung SH, Chen CH, Cheng HM. Blood pressure variability and cognitive dysfunction: A systematic review and meta-analysis of longitudinal cohort studies. J Clin Hypertens (Greenwich) 2021; 23:1463-1482. [PMID: 34153171 PMCID: PMC8678719 DOI: 10.1111/jch.14310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/22/2021] [Accepted: 05/29/2021] [Indexed: 01/13/2023]
Abstract
The variability of blood pressure (BPV) has been suggested as a clinical indicator for cognitive dysfunction, yet the results from clinical studies are variable. This study investigated the relationship between BPV and the risk of cognitive decline or dementia. Bibliographic databases, including PubMed, Scopus, and Embase, were searched systematically for longitudinal cohort studies with BPV measurements and neuropsychological examinations or dementia diagnosis. A traditional meta‐analysis with subgroup analysis, and a further dose‐response meta‐analysis were conducted. Twenty cohort studies with 7 924 168 persons were included in this review. The results showed that a higher systolic BPV (SBPV), when measured with the coefficient of variation (SBP‐CV) or standard deviation (SBP‐SD), was associated with a higher risk of all‐cause dementia diagnosis but not incidence of cognitive decline on neuropsychological examinations. In subgroup analysis, the effect was more prominent when using BPV of shorter timeframes, during shorter follow‐ups, or among the elderly aged more than 65 years. No dose‐response relationship could be found. Our study suggested possible positive associations between SBPV and the risk of dementia. Further studies are required to validate these findings.
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Affiliation(s)
- Tzu-Jung Chiu
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Jiunn-Tyng Yeh
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Chi-Jung Huang
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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