References

rpcardio

Rational Pharmacotherapy in Cardiology

Рациональная Фармакотерапия в Кардиологии

1819-64462225-3653

«SILICEA-POLIGRAF» LLC

10.20996/1819-6446-2019-15-2-258-264

rpcardio-1923

Research Article

POINT OF VIEW

ТОЧКА ЗРЕНИЯ

Cognitive impairment in patients with arterial hypertension: a relationship with the level and daily blood pressure profile and pathogenetic mechanisms

Когнитивные нарушения у пациентов с артериальной гипертензией: взаимосвязь с уровнем и суточным профилем артериального давления и патогенетические механизмы

Остроумова

Т. М.

Ostroumova

T. M.

Остроумова Татьяна Максимова - ассистент, кафедра нервных болезней и нейрохирургии, лечебный факультет, Сеченовский Университет.

119991, Москва, ул. Трубецкая, 8, стр. 2

Tatiana M. Ostroumova - MD, Assistant, Chair of Nervous Diseases and Neurosurgery, Sechenov University.

Trubetskaya ul. 8-2, Moscow, 119991

Парфенов

В. А.

Parfenov

V. A.

Парфенов Владимир Анатольевич - доктор медицинских наук, профессор, заведующий кафедрой нервных болезней и нейрохирургии, Сеченовский Университет.

119991, Москва, ул. Трубецкая, 8, стр. 2

Vladimir A. Parfenov - MD, PhD, Professor, Head of Chair of Nervous Diseases and Neurosurgery, Sechenov University.

Trubetskaya ul. 8-2, Moscow, 119991

Остроумова

О. Д.

Ostroumova

O. D.

Остроумова Ольга Дмитриевна - доктор медицинских наук, профессор, кафедра клинической фармакологии и пропедевтики внутренних болезней, Сеченовский Университет; заведующий лабораторией клинической фармакологии и фармакотерапии, Российский геронтологический научно-клинический центр, РНИМУ им. Н.И. Пирогова.

119991, Москва, ул. Трубецкая, 8, стр. 2; 129226, г. Москва, ул. 1-ая Леонова, 16

Olga D. Ostroumova - MD, PhD, Professor, Chair of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov University; Head of Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center, Pirogov RNRMU.

Trubetskaya ul. 8-2, Moscow, 119991; Pervaya Leonova ul. 1 6, Moscow, 1 29226

ostroumova.olga@mail.ru

Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation

Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет); ОСП Российский геронтологический научно-клинический центр, Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University); Russian Clinical and Research Center of Gerontology, Pirogov Russian National Research Medical UniversityRussian Federation

2019

05052019

152258264

2019

Остроумова Т.М., Парфенов В.А., Остроумова О.Д.

Ostroumova T.M., Parfenov V.A., Ostroumova O.D.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.rpcardio.online/jour/article/view/1923

Arterial hypertension (HT) is one of the main recognized risk factors for the development of cognitive impairment and dementia. The results of most studies indicate that the presence of HT in elderly and senile people is associated with a decrease in cognitive functions and an increased risk of dementia in people of this age group, although some studies have identified the so-called "U-shaped curve”. The state of cognitive functions in middle-aged patients with HT has been studied to a much lesser extent, but it has been established that the presence of HT in middle age is associated with deterioration of cognitive functions and an increased risk of dementia in the elderly. In middle-aged hypertensive patients, cognitive impairment affected all cognitive domens, but to a greater extent - neurodynamic indicators of cognitive functions (speech activity, ability to concentrate, speed of cognitive processes). There are few data that levels of systolic blood pressure (BP) during the day, during wakefulness and sleep periods, insufficient night BP decrease, increased daily BP variability, and increased magnitude of the morning BP rise are interrelated with deterioration of the control functions/speed of cognitive processes. Pathogenetic aspects of the relationship of cognitive impairment and HT are diverse and include the hyperactivation of neuro-humoral systems (renin-angiotensin-aldosterone and sympathoadrenal, hypothalamic-pituitary-adrenal system dysfunction, reduction of cerebral perfusion, endothelial dysfunction. Anxiety-depressive disorders are of great importance in the occurrence of cognitive impairment in patients with HT, their interrelation is complex, dualistic, possibly due to a decrease in brain perfusion.

Артериальная гипертензия (АГ) является одним из главных общепризнанных факторов риска развития когнитивных нарушений и деменции. Результаты большинства исследований свидетельствуют, что наличие АГ у лиц пожилого и старческого возраста ассоциируется со снижением когнитивных функций и повышенным риском развития деменции у лиц данной возрастной группы, хотя в некоторых исследованиях выявлена так называемая «U-образная кривая». Cjстояние когнитивных функций у пациентов с АГ среднего возраста изучено в значительно меньшей степени, однако установлено, что наличие АГ в среднем возрасте ассоциировано с ухудшением когнитивных функций и повышенным риском развития деменции в пожилом. У больных АГ среднего возраста когнитивные расстройства затрагивали все сферы когнитивной деятельности, но в большей степени - нейродинамические показатели когнитивных функций (речевая активность, способность концентрации внимания, скорость когнитивных процессов). Имеются немногочисленные данные, что с ухудшением управляющих функций/скорости когнитивных процессов взаимосвязаны уровни систолического артериального давления (АД) в течение суток, в периоды бодрствования и сна, недостаточная степень ночного снижения АД, повышенная суточная вариабельность АД, увеличение величины утреннего подъема АД. Патогенетические аспекты взаимосвязи когнитивных нарушений и АГ многообразны, и включают гиперактивацию нейро-гуморальных систем (ренин-ангиотензин-альдостероновой и симпатоадреналовой), дисфункцию гипоталамо-гипофизарно-надпочечниковой системы, снижение перфузии головного мозга, дисфункцию эндотелия. В возникновении когнитивных нарушений у больных АГ большое значение имеют тревожно-депрессивные расстройства, их взаимосвязь имеет сложный, дуалистичный характер, возможно, обусловленный снижением перфузии головного мозга.

артериальная гипертензиякогнитивные функциисуточное мониторирование артериального давленияпатогенетические механизмы

essential arterial hypertensioncognitive functions24-hour blood pressure monitoringpathogenetic mechanisms

References1

Williams B., Mancia G., Spiering W. et al.; Authors/Task Force Members. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041. doi:10.1097/HJH.0000000000001940.

Obisesan TO., Obisesan O.A., Martins S. et al. High blood pressure, hypertension, and high pulse pressure are associated with poorer cognitive function in persons aged 60 and older: the Third National Health and Nutrition Examination Survey. J Am Geriatr Soc. 2008;56:501-9. doi:10.1111/j.15325415.2007.01592.x.

Kuo H.K., Sorond IF, Iloputaife I. et al. Effect of blood pressure on cognitive functions in elderly persons. J Gerontol A Biol Sci Med Sci. 2004;59:1191-4. doi:10.1111/j.1532-5415.2007.01592.x.

Waldstein S.R., Giggey P.P., Thayer J.F, Zonderman A.B. Nonlinear relations of blood pressure to cognitive function: the Baltimore Longitudinal Study of Aging. Hypertension. 2005;45:374-9. doi:10.1161/01.HYP.0000156744.44218.74.

Elias M.F, Wolf PA., D'Agostino R.B. et al. Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study Am J Epidemiol. 1993;138:353-64.

Launer L.J., Masaki K., Petrovitch H. et al. The association between midlife blood pressure levels and late-life cognitive function: the Honolulu-Asia Aging Study, JAMA. 1 995;274:1846-51.

Elias P.K., Elias M.F, Robbins M.A., Budge M.M. Blood pressure related cognitive decline: does age make a difference? Hypertension. 2004;44:631-6. doi:10.1161/01.HYP.0000145858.07252.99

Debette S., Seshadri S., Beiser A. et al. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline. Neurology 2011 ;77:461-8. doi:10.1212/WNL.0b013e318227b227.

Kohler S., Baars M.A., Spauwen P. et al. Temporal evolution of cognitive changes in incident hypertension: prospective cohort study across the adult age span. Hypertension. 2014;63:245-51. doi:10.1161/hYPERTENSIONAHA.113.02096.

Парфенов В.А., Старчина Ю.А. Когнитивные нарушения у пациентов с артериальной гипертензией и их лечение. Неврология, Нейропсихиатрия, Психосоматика. 2011 ;3(1):27-33. doi:10.14412/2074-2711-2011-130.

Parfenov VA., Starchina YA., Parfenov V.A., Starchina YA. Cognitive disorders in patients with essential hypertension and their treatment. Neurology, Neuropsychiatry, Psychosomatics. 2011 ;3(1):27-33. (In Russ.) doi:10.14412/2074-2711-2011-130.

Cui J., Yu R., Li M. et al. Intervention affects the cognitive performance of middle-aged patients with essential hypertension. Int J Clin Exp Med 2016;9(1):308-315.

Shehab A., Abdulle A. Cognitive and autonomic dysfunction measures in normal controls, white coat and borderline hypertension.). BMC Cardiovasc Disord. 2011 ;11:3. doi:10.1186/1471-2261-11-3.

Парфенов В.А., Остроумова Т.М., Остроумова О.Д., Павлеева Е.Е. Особенности клинической картины у пациентов среднего возраста с эссенциальной артериальной гипертензией. Терапевтический Архив. 2018;90(9): 1 5-26. doi:10.26442/terarkh20189091526.

Parfenov V.A., Ostroumova ТМ., Ostroumova O.D., Pavleyva E.E.. Features of the clinical picture in patients of middle age with essential hypertension. Tharapeutic Archive. 2018;90(9):1 5-26. (In Russ.). doi:10.26442/terarkh20189091526.

Obisesan TO., Obisesan O.A., Martins S. et al. High blood pressure, hypertension, and high pulse pressure are associated with poorer cognitive function in persons aged 60 and older: the Third National Health and Nutrition Examination Survey J Am Geriatr Soc. 2008;56:501-9. doi:10.1111/j.1532-5415.2007.01592.x.

Waldstein S.R., Rice S.C., Thayer J.F. et al. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging. Hypertension. 2008;51:99-1 04. doi:10.1161/HYPERTENSIONAHA.107.093674.

Kilander L., Nyman H., Boberg M. et al. Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension. 1998; 31:780-6.

Tsivgoulis G., Alexandrov A.V, Wadley V.G. et al. Association of higher diastolic blood pressure levels with cognitive impairment. Neurology 2009;73:589-95. doi:10.1212/WNL.0b013e3181b38969.

White WB., Wolfson L., Wakefield D.B. et al. Average Daily Blood Pressure, not Office Blood Pressure, is Associated with Progression of Cerebrovascular Disease and Cognitive Decline in Older People. Circulation. 2011 ;1 24(21 ):231 2-9. doi:10.1161/CIRCULATIONAHA.111.037036

Conway K.S., Forbang N., Beben T et al. Relationship Between 24-Hour Ambulatory Blood Pressure and Cognitive Function in Community-Living Older Adults: The UCSD Ambulatory Blood Pressure Study. Am J Hypertens. 2015;28(12):1444-52. doi:10.1093/ajh/hpv042.

Gonzalez-Rojas C.A., Pino-Ramirez G., Partida A.G. et al. Ambulatory blood pressure and cognitive function in nondemented older adults: Findings of the maracaibo aging study. Alzheimer's & Dementia: 2010;6(4 Suppl):S477.

Conway K.S., Forbang N., Beben T. et al. Relationship Between 24-Hour Ambulatory Blood Pressure and Cognitive Function in Community-Living Older Adults: The UCSD Ambulatory Blood Pressure Study, Am J Hypertens. 2015;28(12):1444-52. doi:10.1093/ajh/hpv042.

Nagai M., HoshideS., Ishikawa J. et al. Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension. J Hypertens. 2008;26(8):1636-41. doi: 10.1097/HJH.0b013e3283018333.

Okuno J., Yanag H. Cognitive impairment and nocturnal blood pressure fall in treated elderly hypertensives. Environ Health Prev Med. 2003;8(4):124-32. doi:10.1007/BF02897916.

Sierra C., Salamero M., Domenech M. et al. Circadian Blood Pressure Pattern and Cognitive Function in Middle-aged Essential Hypertensive Patients. Rev Esp Cardiol (Engl Ed). 2015;68(2):1 57-8. doi :10.1016/j.rec.2014.09.009.

O'Brien E., Parati G., Stergiou G. et al.; European Society of Hypertension Working Group on Blood Pressure Monitoring Guidelines European Society of Hypertension Position Paper on Ambulatory Blood Pressure Monitoring. Journal of Hypertension. 2013;31 (9):1 731 -68. doi:10.1097/HJH.0b013e328363e964.

Bellelli G., Pezzini A., Bianchetti A., Trabucchi M. Increased blood pressure variability may be associated with cognitive decline in hypertensive elderly subjects with no dementia. Arch Intern Med. 2002;1 62(4):483-4.

Cho N., Hoshide S., Nishizawa M. et al. Relationship Between Blood Pressure Variability and Cognitive Function in Elderly Patients With Good Blood Pressure Control. Am J Hypertens. 2018;31(3):293-8. doi :10.1093/ajh/hpx155.

Kanemary A., Kanemary K., Kuwajima I. The effects of Short-Term blood pressure variability and nighttime blood pressure levels on cognitive function. Hypertens Res. 2001 ;24 (1):19-24.

Sakakura K., Ishikawa J., Okuno M. et al. Exaggerated Ambulatory Blood Pressure Variability Is Associated with Cognitive Dysfunction in the Very Elderly and Quality of Life in the Younger Elderly. AJH. 2007;20(7):720-7. doi:10.1016/j.amjhyper.2007.02.001.

Yamaguchi Y, Wada M., Sato H. et al. Impact of Ambulatory Blood Pressure Variability on Cerebral Small Vessel Disease Progression and Cognitive Decline in Community-Based Elderly Japanese. American Journal of Hypertension. 2014;27(1 0):1 257-67. doi:10.1093/ajh/hpu045.

Mahmoud K.S., Ismail T.T., Saad M. et al. Values of ambulatory blood pressure monitoring for prediction of cognitive function impairment in elderly hypertensive patients. The Egypt Heart J. 2015;67:7-12. doi:10.1016/j.ehj.2014.03.006.

Diz D.I., Lewis K. Dahl memorial lecture: the renin-angiotensin system and aging. Hypertension. 2008;52(1 ):37-43. doi:10.1161/HYPERTENSIONAHA.107.108985.

Bourassa E.A., Sved A.F, Speth R.C. Angiotensin modulation of rostral ventrolateral medulla (RVLM) in cardiovascular regulation. Mol Cell Endocrinol. 2009;302(2):167-75. doi:10.1016/j.mce.2008.10.039.

Katusic Z.S., Austin S.A. Endothelial nitric oxide: protector of a healthy mind. Eur Heart J. 2014;35(1 4):888-94. doi:10.1093/eurheartj/eht544.

Chen B.R., Kozberg M.G., Bouchard M.B. et al. A critical role for the vascular endothelium in functional neurovascular coupling in the brain. J Am Heart Assoc. 2014;3(3):e000787.doi:10.1161/JAHA.114.000787.

Faraci FM. Protecting against vascular disease in brain. Am J Physiol Heart Circ Physiol. 2011 ;300 (5):H1 566-82. doi:10.1152/ajpheart.01310.2010.

Di Marco L.Y, Venneri A., Farkas E. et al. Vascular dysfunction in the pathogenesis of Alzheimer's disease: a review of endothelium-mediated mechanisms and ensuing vicious circles. Neurobiol Dis. 2015;82:593-606. doi:10.1016/j.nbd.2015.08.014.

Poggesi A., Pasi M., Pescini F et al. Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: a review. J Cereb Blood Flow Metab. 2016;36(1 ):72-94. doi:10.1038/jcbfm.2015.116.

Hillman E.M. Coupling mechanism and significance of the BOLD signal: a status report. Annu Rev Neurosci. 2014;37:161-81. doi:10.1146/annurev-neuro-071013-014111.

Jennings J.R., Muldoon M.F, Ryan C. et al. Reduced cerebral blood flow response and compensation among patients with untreated hypertension. Neurology. 2005;64(8):1 358-65. doi:10.1212/01.WNL.0000158283.28251.3C.

Iadecola C. The pathobiology of vascular dementia. Neuron. 2013;80 (4):844-66. doi:10.1016/j.neuron.2013.10.008.

Gualtieri C.T, Morgan D. The frequency of cognitive impairment in patients with anxiety, depression and bipolar disorder: an uncounted source of variance in clinical trials. J Clin Psychiatry. 2008;69(7):1 1 22-30.

Ho А.К., Thorpe C.T, Pandhi N. et al. Association of Anxiety and Depression with Hypertension Control: A U.S. Multi-Disciplinary Group Practice Observational Study. J Hypertens. 2015;33(1 1):221 522. doi: 10.1097/HJH.0000000000000693.

Оганов РГ, Ольбинская Л.И., Смулевич А.Б. и др. Депрессии и расстройства депрессивного спектра в общемедицинской практике. Результаты программы КОМПАС. Кардиология. 2004; 44( 1 ):48-54.

Oganov R.G., Olbinskaya L.I., Smulevich A.B. et al. Depressions and Disorders of Depressive Spectrum in General Medical Practice. Results of the COMPAS program. Kardiologia. 2004;44(1):48-54. (In Russ.)

Ginty A.T., Carroll D., Roseboom T.J. et al. Depression and anxiety are associated with a diagnosis of hypertension 5 years later in a cohort of late middle-aged men and women. J Hum Hypertens. 2013;27(3):187-90. http://dx.doi.org/10.1038/jhh.2012.18

Bacon S.L., Campbell T.S., Arsenault A., Lavoie K.L. The impact of mood and anxiety disorders on incident hypertension at one year. Int J Hypertens. 2014;201 4:953094. doi:10.1155/2014/953094.

Gangwisch J.E., Malaspina D., Posner K. et al. Insomnia and Sleep Duration as Mediators of the Relationship Between Depression and Hypertension Incidence Am J Hypertens. 2010;23(1):62-9. doi:10.1038/ajh.2009.202.

Saavedra J.M., Ando H., Armando I. et al. Anti-stress and anti-anxiety effects of centrally acting angiotensin II AT1 receptor antagonists. Regul Pept. 2005;1 28(3):227-38. doi:10.1016/j.reg-pep.2004.12.01 5.

Baj ko Z., Szekeres C.C., Kovacs K.R. et al. Anxiety, depression and autonomic nervous system dysfunction in hypertension. J Neurol Sci. 2012;317(1 -2):112-6. doi:10.1016/j.jns.2012.02.014.

Kudielka B.M., Wust S. Human models in acute and chronic stress: assessing determinants of individual hypothalamus-pituitary-adrenal axis activity and reactivity. Stress. 2009;13(1 ):1-14. doi :10.3109/10253890902874913.

Hashimoto K., Makino S., Hirasawa R. et al. Abnormalities in the hypothalamo-pituitary-adrenal axis in spontaneously hypertensive rats during development of hypertension. Endocrinology. 1989;125(3):1161-7.

Wolitzky-Taylor K.B., Castriotta N., Lenze E.J. et al. Anxiety disorders in older adults: A comprehensive review. Depress Anxiety 2010;27(2):1 90-21 1. doi:10.1002/da.20653.

Alosco M.L., Gunstad J., Beard C. et al. The Synergistic Effects of Anxiety and Cerebral Hypoperfusion on Cognitive Dysfunction in Older Adults with Cardiovascular Disease. J Geriatr Psychiatry Neurol. 2015;28(1 ):57-66. doi:10.1177/0891988714541871.

Cisler J.M., Olatunji B.O., Feldner M.T, Fosyth J.P. Emotion regulation and the anxiety disorders: An integrative review. J Psychopathol Behav Assess. 2010;32(1):68-82. doi:10.1007/s10862-009-9161-1.

Etkin A., Prater K.E., Hoeft F. et al. Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder. Am J Psychiatry. 2010;1 67(5):545-54. doi:10.1176/appi.ajp.2009.09070931.

The authors declare that there are no conflicts of interest present.