Deborah Brauser

May 22, 2015

NEW YORK CITY, NY — Middle-aged and older individuals with masked hypertension may be at risk for cognitive decline, or vice versa, suggests new research[1].

A study of more than 500 Japanese adults, ambulatory and living independently (and without a clinical diagnosis of dementia), showed that those with masked hypertension were more than twice as likely to have cognitive dysfunction, as measured on the Mini-Mental State Examination (MMSE), as those with controlled hypertension.

The findings were presented here at the American Society of Hypertension (ASH) 2015 Annual Scientific Meeting. Coinvestigator Dr Yuichiro Yano (Northwestern University, Chicago, IL) told heartwire from Medscape that the study's take-away message for clinicians is that ambulatory blood-pressure (BP) measures "can reveal the hidden risk of cognitive dysfunction" in this patient population.

In addition, Yano noted that because the CV risks associated with masked hypertension (such as target organ damage and stroke) have been reported regardless of race/ethnicity, "we expect that our results may be generalizable to other race/ethnic groups." However, he added that replication in different cohorts is warranted.

Test for Identifying At-Risk Patients

A total of 587 hypertensive patients 40 years of age or older (58% women; mean age 72.9 years) were enrolled in the study.

Office and 24-hour BP monitoring occurred for all participants and showed that 15.8% had masked hypertension (office BP <140/90 mm Hg, 24-hour BP >130/80 mm Hg). In addition, 21.7% had white-coat hypertension (>140/90 and <130/80, respectively), 46.3% had sustained hypertension (>140/90 and >130/80, respectively), and the remaining 16.3% were considered to have well-controlled BP (<140/90 and <130/80, respectively).

Participants with the lowest quartile scores on the MMSE (mean 24 points) were considered to have cognitive dysfunction (n=183).

The lowest adjusted mean MMSE scores were found in the masked-hypertension group, followed by the sustained hypertension group. The odds ratio for cognitive dysfunction in those with masked hypertension was 2.4 (95% CI 1.1–5.0) vs the controlled hypertension group (P=0.03). In addition, multiple regression models showed that this association held even after adjustment for age, sex, current smoking or daily drinking, body-mass index (BMI), diabetes status, preexisting CVD, or use of any antihypertensive drug.

The investigators note in the abstract that the findings suggest that a simple cognitive function test "may be useful for identifying older hypertensive patients at risk for high BP outside the office."

First-of-Its-Kind Study?

"I'm really interested to see these findings and was not aware of a previous study like this," the director of the Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention, Dr Barbara Bowman (Atlanta, GA), told heartwire .

"We're getting increasingly interested in masked and white-coat hypertension in the US. So it was really intriguing to me to see the differences the investigators seemed to find in the Mini-Mental State Exam scores between the groups," commented Bowman, who was not involved with the research.

She said she was also impressed "that it was a pretty good-sized study" to be looking into these issues in relatively healthy individuals. "So this [finding for masked hypertension] might be a sign of functional decline to come."

Dr William Haley (Mayo Clinic, Jacksonville, FL) agreed but pointed out that the MMSE "is not terribly detailed" and wished that the investigators had used a different, "more reliable measure of cognitive decline." Still, "it's an interesting take," he said, adding that, like Bowman, he didn't know of any other studies assessing these associations with cognitive dysfunction.

However, he reported that in an ancillary study of the SPRINT trial, which he is part of and that is assessing effect of hypertension management on nighttime blood pressure, cognitive decline is being measured "with a variety of quite extensive panels of testing."

"I think we'll have a much better bead on this [association between masked hypertension and cognitive dysfunction] when we get our data out of the SPRINT trial," which is scheduled to wrap next summer, said Haley.

Yano and Haley report no relevant financial relationships.


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