Subclinical Mood and Cognition Impairments and Blood Pressure Control in a Large Cohort of Elderly Hypertensives

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• 作者：Karolina Piotrowicz ; MD ; PhD^a ; Aleksander Prejbisz ; MD ; PhD^b ; Marek Klocek ; MD ; PhD^c ; Roman Topó ; r-Mądry ; MD ; PhD^d ; Paulina Szczepaniak ; MSc^e ; Kalina Kawecka-Jaszcz ; MD ; PhD^c ; Krzysztof Narkiewicz ; MD ; PhD^f ; Tomasz Grodzicki ; MD ; PhD^a ; Andrzej Januszewicz ; MD ; PhD^b ; Jerzy Gąsowski ; MD ; PhD^a ; ^{jerzy.gasowski@uj.edu.pl" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Cognitive impairment ; mood disturbances ; subclinical ; BP control ; elderly ; survey
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 September 2016
• 年：2016
• 卷：17
• 期：9
• 页码：864.e17-864.e22
• 全文大小：552 K

文摘

Blood pressure (BP) control in the elderly is often limited by poor compliance with prescribed regimen. Both can be influenced by clinical cognitive or mood impairments; however, the impact of subclinical alterations of cognition or mood remains unknown.

Objectives

To assess the relation between cognition, mood, and BP control in treated older hypertensive patients.

Design

Cross-sectional association study.

Setting

Predefined substudy to the POLFOKUS nationwide survey investigating the correlates of poor BP control in patients randomly drawn from primary and specialist practices across Poland.

Participants

1988 outpatients ≥65 years of age treated for hypertension for at least 1 year.

Measurements

BP was mean of at least 2 office measurements. We assessed adherence to antihypertensive medications using a questionnaire and performed screening tests for cognitive deficits [Abbreviated Mental Test Score (AMTS)] and mood disorders [Geriatric Depression Scale (GDS)]. In all patients, we used a unified (BP <140/90 mm Hg) and in ≥80 years old a unified or age-specific (<150 mm Hg systolic BP) definition of BP control. We fitted logistic regression models to assess the probability of poor BP control in association with cognitive and mood disturbances.

Results

The mean [standard deviation (SD)] age of 1988 (65.6% women) patients was 73.9 (6.0) years (19.3% ≥80 years old). Cognitive and mood impairments were observed in 8.0% and 37.2%, respectively. Mean systolic and diastolic BP were 141.8 (16.4) and 83.6 (9.5) mm Hg, respectively. According to age-stratified and unified definition of proper BP control, goal BP was achieved in 65.4% and 38.5% patients ≥80 years of age, respectively. In younger patients, the control reached 46%. Globally, 66% patients adhered to antihypertensive medications. Poor compliance was related to cognitive and mood impairments. When unified goal was applied, there was a 15.0% higher risk of finding poor BP control per 1 score lost in AMTS and an 8.0% increase per 1 score gained in GDS (all <em>Pem> < .001).

Conclusion

Poorer BP control is related to subclinical worsening of cognition and mood, which supports widespread use of the Comprehensive Geriatric Assessment even in apparently self-dependent older patients with hypertension.