To examine whether cognitive function is different among the patients with well-controlled, white-coat hypertension, masked hypertension and sustained hypertension in the elderly.Design and Method:
We enrolled 587 older hypertensive patients (mean age: 72 years; 52% were men; 79% had been treated with antihypertensive medications). All patients were ambulatory, lived independently, and were without clinically diagnosed dementia. Cognitive function was assessed by the mini-mental state examination (MMSE). The lowest quartile of the MMSE score distribution was defined as cognitive dysfunction (n = 183: mean MMSE score: 24 points).Results:
The proportion of well-controlled BP cases (office BP [OBP] < 140/90 mmHg and 24-hour BP < 130/80 mmHg), white-coat hypertension (OBP ≥ 140/90 mmHg and 24-hour BP < 130/80 mmHg), masked hypertension (OBP < 140/90 mmHg and 24-hour BP ≥ 130/80 mmHg), and sustained hypertension (OBP ≥ 140/90 mmHg and 24-hour BP ≥ 130/80 mmHg) were 16.3%, 21.7%, 15.8%, and 46.3%, respectively. The estimated mean (95% confidence interval [CI]) scores of MMSE, adjusted for age, sex, and education, were as follows:27.0 (26.4–27.5) points in well-controlled BP cases, 26.8 (26.4–27.2) points in white coat hypertension, 25.9 (25.3–26.5) points in masked hypertension, and 26.1 (25.8–26.4) points in sustained hypertension (trend P = 0.003).Results:
In multiple regression models (n = 587), cognitive dysfunction was associated with the existence of masked hypertension (odds ratio:2.8; 95% CI:1.3–6.2) and sustained hypertension (odds ratio:2.0; 95% CI:1.0–3.6) independent of age, sex, educational attainment, current smoking, daily drinking, use of antihypertensive medications, BMI, diabetes, use of statins, and pre-existing cardiovascular disease (CVD). However, cognitive dysfunction was not associated with the existence of white-coat hypertension (odds ratio:0.9; 95% CI:0.4–1.8).Conclusions:
Masked hypertension and sustained hypertension are associated with cognitive dysfunction in the elderly hypertensive patients.