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Elder Care
Treating Hypertension in Elderly May Delay Cognitive
Decline
May 17, 2006 - Physicians are sometimes reluctant
to aggressively treat the elderly for hypertension because of some risks
and an assumed lack of benefits. A new study presented today, however,
may change some minds. The findings indicate that cognitive function is
adversely affected by exaggerated blood pressure variability, or the
difference between systolic and diastolic readings, in elderly patients
80 years of age and older.
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Although clinicians may be reluctant to treat
older patients aggressively, perhaps because of perceived lower benefits
or possible increased risk of medication side effects, these findings
show the potential value of interventions, said Kenichi Sakakura, M.D.
of the Public Kiwa Clinic in Kumano, Mie, Japan.
The study measured blood pressure and cognitive
function in 101 Japanese outpatients receiving treatment for chronic
diseases such as hypertension, hyperlipidemia, diabetes, chronic
gastritis, and osteoporosis. It was presented in New York City at the
21st Annual Scientific Meeting of the American Society of Hypertension
(ASH 2006).
The purpose of the study was to evaluate the
association between pulse pressure and cognitive function in the very
elderly, specifically those over 80 years old.
Blood pressure was measured via 24-hour ambulatory
blood pressure monitoring (ABPM) and evaluations of cognitive function
utilized the Mini-Mental State Examination (MMSE), an 11-question
measure with a maximum score of 30 points, that tests five areas of
cognitive function: orientation, registration, attention and
calculation, recall, and language. Cognitive dysfunction was defined by
the score of the MMSE. There are several cut-off points for the MMSE (22
points 26 points) and 24 points was chosen as the cut-off point
because all of the patients in the study were 80 years of age and older.
Results showed 24-h systolic BP: 138.1+17.6 mmHg;
24-h diastolic BP: 75.9+8.0 mmHg. Mean MMSE score was 23.1 ± 4.2, and of
those, 55.4 percent of patients were diagnosed with cognitive
dysfunction (<24 points). MMSE scores decreased across the tertiles of
standard deviation of systolic blood pressure readings (SBP) (P=0.02),
indicating lower functioning, but remained significant after controlling
for daytime SBP levels, confirming an independent relationship between
exaggerated blood pressure variability and cognitive dysfunction in the
elderly.
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Seniors
Don't Take Their Blood Pressure Medicine |
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Another study, reported last
week, on the medical records of a group of elderly patients
shows that only 32.9 percent took the drugs prescribed to treat
high blood pressure and high cholesterol, although, they are
more likely to take the blood pressure medicine.
"This study emphasizes the
importance of considering adherence when caring for high-risk
older patients," Dr. Richard H. Chapman of ValuMedics Research
told Reuters Health. "Despite the relatively high cardiovascular
risk" of these patients, surprisingly few were adherent to
prescribed medications.
Chapman reported that adherence
to both classes of drugs fell rapidly to 40.5 percent at the
3-month mark, then to 32.7 percent at 6 months, and stabilized
at 32.9 percent at 1 year. |
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ABPM takes numerous blood pressure readings over a
24-hour period, and is considered the most accurate measurement of blood
pressure in day-to-day clinical practice. The MMSE is a series of
questions and tests and is most commonly used to evaluate memory
problems in patients suspected of having dementia. Standard deviation
(SD) of daytime systolic blood pressure (SBP) was also calculated as a
measure of blood pressure variability.
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About Hypertension |
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Hypertension is defined as
abnormally high arterial blood pressure that is usually
indicated by an adult systolic blood pressure of 140 mm Hg or
greater or a diastolic blood pressure of 90 mm Hg or greater, is
chiefly of unknown cause but may be attributable to a
preexisting condition (as a renal or endocrine disorder), that
typically results in a thickening and inelasticity of arterial
walls and hypertrophy of the left heart ventricle, and that is a
risk factor for various pathological conditions or events (as
heart attack, heart failure, stroke, end-stage renal disease, or
retinal hemorrhage)
"Systolic" - the contraction of
the heart, during which blood is pumped into the arteries.
"Diastolic" - the expansion of
the chambers of the heart at each heartbeat, during which they
fill with blood. |
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Previous research that was published in
Hypertension: Journal of the American Heart Association in 2004
evaluated blood pressure effects on cognitive performance on 529
patients who were divided into two age groups: 18 to 46 years and 47 to
83 years.
The data showed that there was a correlation
between higher blood pressure and decline in cognitive function over
time in both age groups. The lead investigator suggested that lowering
the systolic blood pressure by 20mmHg or diastolic blood pressure by
10mmHg would have a considerable beneficial effect on the preservation
of cognitive abilities in the whole population.
Calling for deeper investigation, Dr. Sakakura also
said, These results further validate previous indications that variable
blood pressure has an effect on cognitive function in the very elderly.
However, very little data exists to support these theories, and more
research is needed to confirm the full impact of blood pressure on
cognitive function in these patients.
About the American Society of Hypertension
The American Society of Hypertension (ASH) is the
largest US organization devoted exclusively to hypertension and related
cardiovascular diseases. ASH is committed to alerting physicians, allied
health professionals and the public about new medical options, facts,
research findings and treatment choices designed to reduce the risk of
cardiovascular disease.
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