The state of cognitive functions and their correlation with subclinical structural changes of the carotid artery and the incidence of hypertensive crises in patients with arterial hypertension
Background. Cognitive impairment is the most common manifestation of brain damage in patients with arterial hypertension and can be considered an indicator of brain damage in this disease. Currently, attention is being paid to the assessment of atherosclerotic changes in carotid arteries, which play an important role in cerebrovascular diseases and cognitive impairment. The intima-media thickness of the common carotid artery is the most informative early (subclinical) marker of atherosclerosis. Of particular interest is to investigate the effect of subclinical changes in the carotid arteries on cognitive impairment in hypertension. The purpose of the study was to analyze the correlation between cognitive impairment and subclinical changes in carotid arteries in patients with hypertensive disease, depending on the incidence of crises. Materials and methods. Sixty nine patients with stage II essential hypertension were examined, average age was 51.38 ± 0.94 years. Patients were divided into 2 groups: the first one — with no cognitive impairment (38 patients), the second one — with the detected cognitive impairment (according to the MoCA-test) — 31 patients. For the study of cognitive impairment, the Montreal Evaluation Scale was used. The examination of the right common carotid artery was carried out using an ultrasound multifunctional scanner. Results. The average intima-media thickness in patients of the first and second groups was not significantly different. The proportion of intima-media thickness exceeding normal values (> 0.9 and < 1.3 mm) was significantly higher in persons with cognitive impairment (71 %) than in those without them (39.5 %). The correlation analysis showed a negative relationship between the incidence of hypertensive crises in patients with essential hypertension in the presence of cognitive impairment and the sum of the MoCA test scores (r = –0.51, p < 0.05) and positive — with intima-media thickness in both groups of patients (r = +0.64, p < 0.05 and r = +0.75, p < 0.01, accordingly). A positive correlation of hypertensive crises disease and intima-media thickness was found only in persons with cognitive impairment (r = +0.62, p < 0.05). Сonclusions. An increase in the carotid intima-media thickness is noted in patients with essential hypertension, which also depends on the incidence of hypertensive crises. However, the dependence of cognitive impairments on the incidence of hypertensive crises is detected only in patients with elevated values of the intima-media thickness.
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