Henrique Muela

Hypertension Severity Is Associated With Impaired Cognitive Performance

Background Most evidence of target‐organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. Methods and Results In a cross‐sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN‐1: BP, 140–159/90–99 or use of 1 or 2 antihypertensive drugs; HTN‐2: BP, ≥160/100 or use of ≥3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini–Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage‐1, the severe HTN group had worse cognitive performance based on Mini–Mental State Examination (26.8±2.1 vs 27.4±2.1 vs 28.0±2.0; P=0.004) or Montreal Cognitive Assessment (23.4±3.7 vs 24.9±2.8 vs 25.5±3.2; P<0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. Conclusions Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.

Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini‐Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini‐Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima‐media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.

Prognostic Value of Serum Uric Acid in Patients on the Waiting List before and after Renal Transplantation

Background. High serum uric acid (UA) is associated with increased cardiovascular (CV) risk in the general population. The impact of UA on CV events and mortality in CKD is unclear. Objective. To assess the relationship between UA and prognosis in hemodialysis (HD) patients before and after renal transplantation (TX). Methods. 1020 HD patients assessed for CV risk and followed from the time of inception until CV event, death, or TX (HD) or date of TX, CV event, death, or return to dialysis (TX). Results. 821 patients remained on HD while 199 underwent TX. High UA (≥428 mmol/L) was not associated with either composite CV events or mortality in HD patients. In TX patients high UA predicted an increased risk of events (P = 0.03, HR 1.6, and 95% CI 1.03–2.54) but not with death. In the Cox proportional model UA was no longer significantly associated with CV events. Instead, a reduced GFR (<50 mL/min) emerged as the independent risk factor for events (P = 0.02, HR 1.79, and % CI 1.07–3.21). Conclusion. In recipients of TX an increased posttransplant UA is related to higher probability of major CV events but this association probably caused concurrent reduction in GFR.

Coronary events in obese hemodialysis patients before and after renal transplantation

We examined the impact of obesity (BMI ≥30 kg/m2, n = 357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End‐points were coronary events, composite cardiovascular (CV) events, and death. Obese HD patients were older (55.9 ± 9.2 vs. 54.2 ± 11), had more diabetes (54% vs. 40%), dyslipidemia (49% vs. 30%), altered myocardial scan (38% vs. 31%), myocardial infarction (MI) (16% vs. 10%), coronary intervention (11% vs. 7%), higher total cholesterol (186 ± 52 vs. 169 ± 47), and triglycerides (219 ± 167 vs. 144 ± 91). Obese undergoing TX had more dyslipidemia (46% vs. 31%), angina (23% vs. 14%), MI (18% vs. 5%), increased total cholesterol (185 ± 56 vs. 172 ± 48), and triglycerides (237 ± 190 vs. 149 ± 100). Obesity was independently associated with coronary events (log‐rank = 0.008, HR 2.55% CI 1.27–5.11) and death (log‐rank 0.046, HR 1.52, % CI 1.007–2.30) in TX but not in HD. Obese HD patients had more risk factors and ischemic heart disease, but these characteristics did not interfere with prognosis. In TX patients, obesity predicts coronary events and death.

Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance

ABSTRACT. Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.

Intermittent claudication and severe renal artery stenosis are independently associated in hypertensive patients referred for renal arteriography

OBJECTIVE: The purpose of this study was to evaluate the association between the presence of clinical symptoms of peripheral artery disease and severe renal artery stenosis in patients referred for renal angiography. METHOD: We included 82 patients with clinical suspicion of renovascular hypertension and performed an imaging investigation (renal Doppler ultrasound and/or renal scintigraphy) for possible renal artery stenosis. All patients underwent renal arteriography and were examined for peripheral artery disease based on the presence of intermittent claudication and ankle-brachial index test results. Severe renal artery stenosis was defined as a lesion causing 70% obstruction. RESULTS: Severe renal artery stenosis was present in 32 of 82 (39%) patients. Patients with severe renal artery stenosis were older (63±12 vs 56±12 years, p=0.006), had more intermittent claudication (55 vs 45%, p=0.027), and had a greater prevalence of an ankle-brachial index <0.9 (44% vs 20%, p=0.021) than patients without severe renal artery stenosis. Multivariate logistic regression analysis showed that the presence of intermittent claudication was independently associated with renal artery stenosis ≥70% (OR: 3.33; 95% CI 1.03–10.82, p=0.04), unlike the ankle-brachial index, which showed no association (OR: 1.44; 95% CI 0.37–5.66, p=0.60). CONCLUSION: Intermittent claudication is independently associated with severe renal artery stenosis (≥70%) in patients clinically suspected of having renovascular hypertension.

[OP.3C.03] ARTERIAL STIFFNESS IS ASSOCIATED WITH LOWER PERFORMANCE ON THE COGNITIVE TESTS AT DIFFERENT DOMAINS IN HYPERTENSIVE PATIENTS.

Objective: To study the cognitive function at different domains and arterial properties in patients with AH stage 1 to 3 compared to normotensives and to evaluate the correlations between these variables. Design and method: We evaluated 162 subjects, 42 normotensives (44.7 ± 11 yrs, 69% male, 88% white) and 120 patients with stage 1–3 AH (51 ± 11 yrs, 46% male, 69% white) under treatment. The global cognitive function was assessed by Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). was done A validated comprehensive battery of neuropsychological tests assessed the following main cognitive areas:memory, language, visuoperceptual and visuospatial, praxia, gnosia, executive function, attention, judgment. Pulse wave velocity (PWV) was measured by Complior® device. Carotid properties were assessed by radiofrequency ultrasound (WTS®). Central arterial pressure and augmentation index (AIx) were obtained using applanation tonometry (Sphygmocor®). Results: Mean BP of the normotensive group (121.9 ± 7/76.1 ± 7 mmHg) was significantly lower than hypertensive patients (141.4 ± 23/87.2 ± 13 mmHg). Hypertensive group had worse performance in cognitive evaluation either by MMSE (27 ± 2 vs. 28.6 ± 1,p < 0.05) or MoCA test (23.8 ± 3 vs. 26.7 ± 2, p < 0.05). On the neuropsychological tests hypertensive patients had worse performance mainly in visuoperceptual and visuospatial capacities and executive function. On the multivariate regression analysis, the following independent associations were observed: PWV-memory, executive function and attention parameters; IMT-memory and executive function; AIx-all neuropsychological domains except memory. Conclusions: Cognitive impairment at different domains was more frequent in patients with different stages of AH. Arterial functional and structural properties were diversely associated with cognitive performance at different domains.

[PP.11.21] GENDER DIFFERENCES OF ARTERIAL STIFFNESS AND CENTRAL BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AND THE INFLUENCE OF MENOPAUSE

Objective: To evaluate differences of central BP and arterial stiffness between men and women with arterial hypertension and the influence of postmenopausal status. Design and method: We studied 128 subjects with stage 1–3 arterial hypertension, mean age 51.1 ± 11 years, 48% males, BP = 141 ± 24/87 ± 13 mmHg, hypertension duration 10.1 ± 8 years. Noninvasive central aortic BP and wave form characteristics (Alx and AIx corrected by heart rate of 75 bpm - Alx75) were synthesized from radial arterial pressure waves (applanation tonometry) by SphygmoCor®. Brachial BP was obtained by an automatic device(OMRON®). Results: Brachial systolic BP was higher (145 ± 26 vs. 136 ± 20 mmHg, p = 0.04) and, weight (76.2 ± 14 vs. 86.4 ± 13.2, p < 0.01) and height (1.59 ± 0.06 vs. 1.72 ± 0.08, p < 0.01) were lower in females than in males. Central systolic BP (137 ± 30 vs 125 ± 23 mmHg, p < 0.01), Alx (32.7 ± 9.8 vs 19.5 ± 11.7, p < 0.01), Alx75 (29.6 ± 6.9 vs 18.0 ± 9.3, p < 0.01) were higher in females, even after adjustments for weight, height and systolic BP. Postmenopausal status was present in 70% of females and mean age of menopause beginning was 47.8 years. Women at postmenopausal status older than 48 years showed worse AIX () than younger women () and also than men () at same age (p < 0.05). Conclusions: Hypertensive females have higher brachial and central systolic BP than hypertensive males. Arterial stiffness is higher in hypertensive females than in men, at all ages, and in postmenopausal status is worse than in fertile period.