Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T05:28:22.241Z Has data issue: false hasContentIssue false
  • English
  • Français

Vascular risk factors and cognitive function among 3763 participants in the Hypertension in the Very Elderly Trial (HYVET): a cross-sectional analysis

Published online by Cambridge University Press:  27 February 2009

Ruth Peters ,
Nigel Beckett ,
Françoise Forette ,
Jaakko Tuomilehto ,
Craig Ritchie ,
Ivan Walton ,
Adam Waldman ,
Robert Clarke ,
Ruth Poulter  and
Astrid Fletcher
...Show all authors
Ruth Peters*
Affiliation:
Care of the Elderly, Imperial College Faculty of Medicine, London, U.K.
Nigel Beckett
Affiliation:
Imperial College Faculty of Medicine, London, U.K.
Françoise Forette
Affiliation:
Le Groupe Hospitalier Broca, Paris, France
Jaakko Tuomilehto
Affiliation:
National Public Health Institute, Helsinki, Finland
Craig Ritchie
Affiliation:
Imperial College Faculty of Medicine, London, U.K.
Ivan Walton
Affiliation:
Imperial College Healthcare NHS Trust, London, U.K.
Adam Waldman
Affiliation:
Imperial College Healthcare NHS Trust, London, U.K.
Robert Clarke
Affiliation:
Clinical Trials Research Unit, University of Oxford, U.K.
Ruth Poulter
Affiliation:
Care of the Elderly, Imperial College Faculty of Medicine, London, U.K.
Astrid Fletcher
Affiliation:
Department of Epidemiology and Population Heath, London School of Hygiene and Tropical Medicine, London, U.K.
Christopher Bulpitt
Affiliation:
Care of the Elderly, Imperial College Faculty of Medicine, London, U.K.
*
Correspondence should be addressed to: Dr. Ruth Peters, Care of the Elderly, Imperial College Faculty of Medicine, Du Cane Rd, London W12 0NN, U.K. Tel. +44 (0)20 83833959; Fax. +44 (0)20 83833378. Email: [email protected].
Get access

Abstract

Background: It is well known that the global population is aging and that those over the age of 80 are the fastest growing part of this expansion. Also known is that prevalence of hypertension and cognitive decline both increase with increasing age.

Method: The Hypertension in the Very Elderly Trial (HYVET) was a double blind placebo-controlled trial of antihypertensive treatment (indapamide SR 1.5 mg ± perindopril 2–4 mg) and recruited only those hypertensives who were aged 80 or over and were without a diagnosis of dementia at baseline. Systolic blood pressure had to be in the range 160–199 mmHg and diastolic pressure <110 mmHg. Cognitive function was assessed at baseline using the Mini-mental State Examination prior to randomization into the trial. Also collected at baseline was information relating to sociodemographic, clinical, cardiovascular and biochemical factors which may impact upon cognitive function. This paper reports on the baseline cognitive function data from the HYVET trial and its relationship to these factors.

Results: The mean age of the 3763 HYVET participants who had full cognitive function data at baseline was 83.6 years; 60 percent were female. The median MMSE score at baseline was 26 and, in multivariate analyses, higher at younger age, with male gender, higher educational level, having higher creatinine, higher total cholesterol and lower high-density lipoprotein cholesterol.

Conclusions: This is the first such study to examine a large number of very elderly hypertensives and it shows some similar patterns to those seen in younger elderly groups.

Keywords

hypertensionHYVETcognitive functionolder adultblood pressureMMSE
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 359 - 368
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anstey, K., Sanden, C., Salim, A. and O'Kearney, R. (2007). Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. American Journal of Epidemiology, 166, 367–378.CrossRefGoogle ScholarPubMed
Arai, H. et al. (2006). Usefulness of measuring serum markers in addition to comprehensive geriatric assessmet for cognitive impairment and depressive mood in the elderly. Geriatric Gerontology International, 6, 7–14.CrossRefGoogle Scholar
Baum, L. (2005). Sex, hormones and Alzheimer's disease. Journal of Gerontology, 60A, 736–743.Google Scholar
Beckett, N. et al. for the HYVET Study Group (2008). Treatment of hypertension in patients 80 years of age or older, New England Journal of Medicine, 358, 1887–1898.CrossRefGoogle ScholarPubMed
Birkenhager, W., Forette, F., Seux, M., Wang, J. and Staessen, J. (2001). Blood pressure, cognitive functions, and prevention of dementias in older patients with hypertension. Archives of Internal Medicine, 161, 152–156.CrossRefGoogle ScholarPubMed
Bulpitt, C. et al. (2001). Hypertension in the Very Elderly Trial (HYVET) protocol for the main trial. Drugs and Aging, 18, 151–164.CrossRefGoogle ScholarPubMed
Cankurtaran, M., Yavuz, B., Halil, M., Dagli, N., Cankurtaran, E. and Ariogul, S. (2005). Are serum lipid and lipoprotein levels related to dementia? Archives of Gerontology and Geriatrics, 41, 31–39.CrossRefGoogle ScholarPubMed
Donini, L., Felice, M. and Cannella, C. (2007). Nutritional status determinants and cognition in the elderly. Archives of Gerontology and Geriatrics, 44, 143–153.CrossRefGoogle ScholarPubMed
Elias, M., Wolf, P., D'Agostino, R., Cobb, J. and White, L. (1993). Untreated blood pressure level is inversely related to cognitive functioning: the Framingham study. American Journal of Epidemiology, 138, 353–364.CrossRefGoogle ScholarPubMed
Feigin, V., Ratnasabapathy, Y. and Anderson, C. (2005). Does blood pressure lowering treatment prevents dementia or cognitive decline in patients with cardiovascular and cerebrovascular disease? Journal of the Neurological Sciences, 229–230, 151–155.CrossRefGoogle Scholar
Fratiglioni, L. et al. for the Neurologic Diseases in the Elderly Research Group (2005). Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology, 54, S10–S15.Google Scholar
Geroldi, C. et al. (2003). Mild cognitive deterioration with subcortical features. prevalence, clinical characteristics, and association with cardiovascular risk factors in community-dwelling older persons (the InCHIANTI Study). Journal of the American Geriatrics Society, 51, 1064–1071.CrossRefGoogle ScholarPubMed
Hersberger, M. and Eckardstein, A. (2003). Low high-density lipoprotein cholesterol: physiological background, clinical importance and drug treatment. Drugs, 63, 1907–1945.CrossRefGoogle ScholarPubMed
Kalmijn, S., Feskens, E., Launer, L. and Kromhout, D. (1996).Cerebrovascular disease, the apolipoprotein e4 allele, and cognitive decline in a community based study of elderly men. Stroke, 27, 2230–2235.CrossRefGoogle Scholar
Kilander, L., Nyman, H., Boberg, M., Hansson, L. and Lithell, H. (1998). Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension, 31, 780–786.CrossRefGoogle ScholarPubMed
Kivipelto, M. et al. (2001). Midlife vascular risk factors and late-life mild cognitive impairment: a population-based study. Neurology, 561, 1689–1689.Google Scholar
Launer, L., Masaki, K., Petrovitch, H., Foley, D. and Havlik, R. (1995). The association between midlife blood pressure levels and late-life cognitive function. JAMA, 274, 1846–1851.CrossRefGoogle ScholarPubMed
Norbury, R. et al. (2003). The neuroprotective effects of oestrogen on the aging brain. Experimental Gerontology, 38, 109–117.CrossRefGoogle ScholarPubMed
Packard, C. et al. for the Prospective Study of Pravastatin in the Elderly at Risk Group. (2007). Association between apolipoprotein e4 and cognitive decline in elderly adults. Journal of the American Geriatrics Society, 55; 1777–1785.CrossRefGoogle ScholarPubMed
Peters, R., Beckett, N., Nunes, M., Fletcher, A., Forette, F. and Bulpitt, C. (2006). A substudy protocol of the Hypertension in the Very Elderly Trial assessing cognitive decline and dementia incidence (an ongoing randomised double blind placebo-controlled trial). Drugs and Aging, 23, 83–92.CrossRefGoogle ScholarPubMed
Peters, R. et al. for the HYVET investigators (2008a). Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurology, 7, 683–689, doi. 10.1016/S1474-4422(08)70143-1.CrossRefGoogle ScholarPubMed
Peters, R., Peters, J., Warner, J., Beckett, N. and Bulpitt, C. (2008b).Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age and Ageing, 37, 505–512.CrossRefGoogle ScholarPubMed
Prospective Studies Collaboration (2007). Blood pressure and vascular mortality by age, sex and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet, 370, 1829–1839.CrossRefGoogle Scholar
Qiu, C., Strauss, E., Fastbom, J., Winblad, B. and Fratiglioni, L. (2003). Low blood pressure and risk of dementia in the Kungsholmen project. Archives of Neurology, 60, 223–228.CrossRefGoogle ScholarPubMed
Qiu, C., Winblad, B. and Fratiglioni, L. (2005). The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurology, 4, 487–499.CrossRefGoogle ScholarPubMed
Ruitenberg, A. et al. (2002). Alcohol consumption and risk of dementia: the Rotterdam study. Lancet, 359, 281–286.CrossRefGoogle ScholarPubMed
Solomon, A. et al. (2007). Serum cholesterol changes after midlife and late-life cognition: twenty-one-year follow-up study. Neurology, 68, 751–756.CrossRefGoogle ScholarPubMed
Spreen, O. and Strauss, E. (1998). A Compendium of Neuropsychological Tests. Administration, Norms and Commentary, 2nd edn. Oxford: Oxford University Press.Google Scholar
Steen, B. (2002). The elderly yesterday, today and tomorrow: aspects on cohort differences from the gerontological and geriatric population studies in Göteburg, Sweden (H70). Archives of Gerontology and Geriatrics, 35, 359–370.CrossRefGoogle Scholar
Stewart, R., White, L., Xue, Q. and Launer, L. (2007). Twenty-six-year change in total cholesterol levels and incident dementia. Archives of Neurology, 64, 103–107.CrossRefGoogle ScholarPubMed
Tzourio, C., Dufouil, C., Ducimetière, P., and Alpérovitch, A. for the EVA Study Group (1999). Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. Neurology, 53, 1948–1952.CrossRefGoogle ScholarPubMed
Vanhanen, H. et al. on behalf of the Syst-Eur Investigators (1996). Associations of orthostatic blood pressure fall in older patients with isolated systolic hypertension. Journal of Hypertension, 14, 943–949.CrossRefGoogle ScholarPubMed
Yaffe, C., Barratt-Connor, E., Lin, F. and Grady, D. (2002). Serum lipoprotein levels, statin use, and cognitive function in older women. Archives of Neurology, 59, 378–384.CrossRefGoogle ScholarPubMed