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Ambulatory blood pressure, asymptomatic cerebrovascular damage and cognitive function in essential hypertension

Journal of Human Hypertension volume 20, pages 5–13 (2006)Cite this article

Abstract

Prolonged exposure to elevated blood pressure (BP) can lead to both structural (white matter lesions (WML) or infarctions) and functional changes in the brain. We studied in previously diagnosed essential hypertensive individuals if diurnal BP variation and ambulatory BP (ABP) profile (daytime, night time and 24-h BP averages) were related to evidence of WML, the presence of ‘silent’ infarcts, and cognitive performance. A group of 86 patients (mean age 57.4±10 years, range 40–80) were first screened for hypertension-related organ damage and underwent 24-h ABP monitoring, magnetic resonance imaging (MRI) of the brain, and a comprehensive neurocognitive assessment. Age and ABP profile were related to more periventricular, but not subcortical, WML and to presence of lacunar infarctions on MRI. After correction for demographical group differences, no association was found between night time dipping of BP on the one hand and both WML load and cognitive parameters (verbal memory, sensorimotor speed, cognitive flexibility) on the other. The presence of lacunar infarctions, however, predicted lower performance on verbal memory. Furthermore, daytime and 24-h pulse pressure averages were associated with pWML, whereas systolic BP and mean arterial pressure (MAP) for daytime, night-time and 24-h periods were higher in patients with lacunar infarctions. Notwithstanding the large variability of WML in this sample, the evidence of a connection between diurnal BP variation and early target organ damage in the brain was not convincing. However, the ABP profile may be predictive of cerebral lesion type.

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Acknowledgements

Grant support for this study by the Dutch Brain Foundation (#6F98.06) and the University Hospital Maastricht (Profileringsfonds, #B00.01.063) is gratefully acknowledged. We also appreciate the assistance of our clinical staff, S Rodriguez, MD, and W Spiering, MD, for the medical data collection, M Bessems for the neuropsychological assessments, and E Magnee for her assistance in data management.

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Authors and Affiliations

  1. Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands

    M P J van Boxtel & J Jolles

  2. Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands

    L H G Henskens, A A Kroon & P W de Leeuw

  3. Department of Radiology, Maastricht University, Maastricht, The Netherlands

    P A M Hofman

  4. Department of Medical Informatics, Maastricht University, Maastricht, The Netherlands

    E H B M Gronenschild

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  1. M P J van Boxtel
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Correspondence to M P J van Boxtel.

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van Boxtel, M., Henskens, L., Kroon, A. et al. Ambulatory blood pressure, asymptomatic cerebrovascular damage and cognitive function in essential hypertension. J Hum Hypertens 20, 5–13 (2006). https://doi.org/10.1038/sj.jhh.1001934

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