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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Clinical characteristics of older adults with hypertension and unrecognized cognitive impairment

Hypertension Research volume 45, pages 612–619 (2022)Cite this article

Abstract

To treat older patients with hypertension, it is important to detect cognitive impairment at an early stage because of its potential influence on treatment efficacy and functional prognosis. In this study, we aimed to identify the incidence and determinants of cognitive impairment in hypertensive patients aged 65 years and above who visited our outpatient clinic and were not previously diagnosed with cognitive impairment. Among 312 patients with hypertension, we found that 35% (n = 109) and 7.7% (n = 24) had cognitive impairment and dementia, respectively, as defined by the Mini-Mental State Examination (≤27 or ≤23, respectively). Patients with cognitive impairment were older, had lower levels of education, and had lower instrumental activities of daily living (IADL) scores than those without cognitive impairment. Multiple regression analysis revealed that age and IADL were associated with cognitive impairment in patients with hypertension. Regarding the treatment of hypertension, the office and home blood pressure levels, number of antihypertensive medications prescribed, and proportion of the use of each antihypertensive drug was equivalent between patients with and without cognitive impairment. Finally, patients with unrecognized cognitive impairment showed distinct clinical characteristics, including high antihypertensive medication burden and preserved IADL, when compared to hypertensive patients in the different cohorts of definitive mild cognitive impairment of a similar age. These findings suggest that older hypertensive patients are at a high risk of masked cognitive decline, even if they are functionally independent.

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Acknowledgements

We are very grateful to Eriko Kimura for her excellent secretarial assistance.

Funding

This work was supported by The Research Funding for Longevity Sciences (30-8) from the National Center for Geriatrics and Gerontology (NCGG), Japan.

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Author notes

  1. These authors contributed equally: Koichi Yamamoto, Hiroshi Akasaka

Authors and Affiliations

  1. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Koichi Yamamoto, Hiroshi Akasaka, Yukiko Yasunobe, Yoichi Takami & Hiromi Rakugi

  2. National Center for Geriatrics and Gerontology, Obu, Japan

    Atsuya Shimizu & Kenichiro Nomoto

  3. Department of Geriatric Medicine, Graduate School of Medicine, Kyorin University School of Medicine, Tokyo, Japan

    Kumiko Nagai & Koichi Kozaki

  4. Department of Community Healthcare & Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Japan

    Hiroyuki Umegaki & Masafumi Kuzuya

  5. Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan

    Yuichi Akasaki & Mitsuru Ohishi

  6. Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Taro Kojima & Masahiro Akishita

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  1. Koichi Yamamoto
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Correspondence to Koichi Yamamoto or Hiromi Rakugi.

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Yamamoto, K., Akasaka, H., Yasunobe, Y. et al. Clinical characteristics of older adults with hypertension and unrecognized cognitive impairment. Hypertens Res 45, 612–619 (2022). https://doi.org/10.1038/s41440-022-00861-z

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