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Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study.
Tuesday,2012-11-06 12:25 America/Los_Angeles — eenright
| Title | Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2011 |
| Authors | Hajjar, I, Quach, L, Yang, F, Chaves, PHM, Newman, AB, Mukamal, K, Longstreth, W, Inzitari, M, Lipsitz, LA |
| Journal | Circulation |
| Volume | 123 |
| Issue | 8 |
| Pagination | 858-65 |
| Date Published | 2011 Mar 01 |
| ISSN | 1524-4539 |
| Keywords | Aged, Aged, 80 and over, Brain, Cognition Disorders, Female, Humans, Hypertension, Kaplan-Meier Estimate, Longitudinal Studies, Magnetic Resonance Imaging, Male, Microcirculation, Mobility Limitation, Mood Disorders, Nerve Fibers, Myelinated, Retrospective Studies, Risk Factors |
| Abstract | <p><b>BACKGROUND: </b>Our objective was to investigate the association between hypertension and concurrent impairments in mobility, cognition, and mood; the role of brain white matter hyperintensities in mediating this association; and the impact of these impairments on disability and mortality in elderly hypertensive individuals.</p><p><b>METHODS AND RESULTS: </b>-Blood pressure, gait speed, digit symbol substitution test, and the Center for Epidemiological Studies Depression Scale were measured yearly (1992-1999) on 4700 participants in the Cardiovascular Health Study (age: 74.7, 58% women, 17% blacks, 68% hypertension, 3600 had brain magnetic resonance imaging in 1992-1993, survival data 1992-2005). Using latent profile analysis at baseline, we found that 498 (11%) subjects had concurrent impairments and 3086 (66%) were intact on all 3 measures. Between 1992 and 1999, 651 (21%) became impaired in all 3 domains. Hypertensive individuals were more likely to be impaired at baseline (odds ratio 1.23, 95% confidence interval 1.04 to 1.42, P=0.01) and become impaired during the follow-up (hazard ratio=1.3, 95% confidence interval 1.02 to 1.66, P=0.037). A greater degree of white matter hyperintensities was associated with impairments in the 3 domains (P=0.007) and mediated the association with hypertension (P=0.19 for hypertension after adjusting for white matter hyperintensities in the model, 21% hazard ratio change). Impairments in the 3 domains increased subsequent disability with hypertension (P<0.0001). Hypertension mortality also was increased in those impaired (compared with unimpaired hypertensive individuals: HR=1.10, 95% confidence interval 1.04 to 1.17, P=0.004).</p><p><b>CONCLUSIONS: </b>Hypertension increases the risk of concurrent impairments in mobility, cognition, and mood, which increases disability and mortality. This association is mediated in part by microvascular brain injury.</p> |
| DOI | 10.1161/CIRCULATIONAHA.110.978114 |
| Alternate Journal | Circulation |
| PubMed ID | 21321150 |
| PubMed Central ID | PMC3081662 |
| Grant List | N01-HC-85085 / HC / NHLBI NIH HHS / United States P01-AG004390 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States K23 AG030057-05 / AG / NIA NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States P01 AG004390 / AG / NIA NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States K23 AG030057-04 / AG / NIA NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States P50 AG005134 / AG / NIA NIH HHS / United States N01 HC-55222 / HC / NHLBI NIH HHS / United States R01 AG 023629 / AG / NIA NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States R37-AG25037 / AG / NIA NIH HHS / United States K23 AG030057 / AG / NIA NIH HHS / United States R37 AG025037 / AG / NIA NIH HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States |