Objective: Ambulatory blood pressure monitoring (ABPM) parameters are more accurately linked to target organ damage than office or home blood pressure values. Few studies focus on the relationship between ABPM parameters and cognitive aging. We aimed to investigate the relationship between ABPM parameters and prevalence of cognitive impairment and dementia among hypertensive patients. Design and method: In the present paper, we included 294 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 50–91years (mean age: 68.6 ± 8.8 years; 50.3% female; 49.7% male). After routine clinical assessment all participants had an ABPM recording (on antihypertensive medical treatment), completed the Montreal Cognitive Assessment (MoCA) test used for the detection of cognitive impairment, and the Mini Mental State Examination (MMSE) test for detection of dementia. We divided patients in two groups acording to cognitive status based on these cutoff values: 26 points for MOCA score, respectively 24 points for MMSE score – and compared ABPM parameters of the two groups. Statistical analysis was performed with the IBM SPSS v.20 program. Results: In patients with cognitive impairment (MOCA <26) we found significantly lower mean diastolic (69.9 vs. 72.4 mmHg, p = 0.023), daytime diastolic (72.0 vs. 75.1 mmHg, p = 0.012), nighttime diastolic (64.5 vs. 66.9 mmHg, p = 0.039), and higher pulse pressure values (average pulse pressure 61.5 vs. 55.5 mmHg, p = 0.002, daytime pulse pressure 61.7 vs. 56.6 mmHg, p = 0.003, nighttime pulse pressure (59.8 vs. 55.1 mmHg, p = 0.004). In patients with dementia (MMSE<24) we found significant differences between nighttime systolic values (129.7 vs. 124.5 mmHg, p = 0.04), average pulse pressure (63.5 vs. 58.9 mmHg, p = 0.038), and nighttime pulse pressure (63.5 vs. 57.4 mmHg, p = 0.003), values compared to patients with normal cognitive function. Conclusions: The presence of cognitive impairment was related to lower diastolic values, and higher pulse pressure values, while dementia was associated with higher nighttime systolic values in the studied patient population. Lowering too much diastolic blood pressure leading to higher pulse pressure and insufficient control of systolic blood pressure over night could have deleterious effect on neurocognitive abilities of treated hypertensive patients.

Introduction Hypertension is an important modifiable risk factor related to cognitive dysfunction. Data suggest that atrial fibrillation (AF) is also associated with an increased risk of cognitive decline, independent of stroke history. Few studies focus on the effect of AF on specific cognitive domains. Purpose We aimed in this study to investigate the prevalence of cognitive dysfunction among hypertensive patients with atrial fibrillation and to evaluate the impact of atrial fibrillation on the affected cognitive domains. Methods In the present paper, we included 488 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 37–93 years (mean age: 68±10 years; 51.84% female; 48.15% male). Diagnosis of AF was based on 12 lead ECG. All types of AF (paroxysmal, persistent and permanent) were included. The prevalence of atrial fibrillation in our sample was 23.77% (n=116), on admission mean heart rate was 76±16 bpm and mean blood pressure 137/82 mmHg (±19/11 mmHg). After routine clinical assessment all participants completed the Montreal Cognitive Assessment (MoCA) test used for the detection of mild cognitive impairment. Depression as a confounding factor on cognitive performances was detected with the shortened 13 items form of Beck Depression Inventory (BDI-13). We compared MoCA scores of the group of patients with atrial fibrillation with scores from the group in sinus rhythm. Statistical analysis was performed with the IBM SPSS v.20 program. Results Impairment in cognitive functions was revealed among hypertensive patients in sinus rhythm vs. with atrial fibrillation according to MoCA in 66.1% (n=246) vs. 81.9% (n=95). Cognitive scores were significantly lower in the atrial fibrillation group vs. patients in sinus rhythm: MoCA: 21.74 vs. 22.97 (p=0.016). The prevalence of depression in the two groups was not statistically different, AF 52.58% vs. 55.34% patients in sinus rhythm (p=0.89). Analysing MoCA's cognitive domains, patients with atrial fibrillation had significantly lower scores in visuospatial/executive (3.09 vs. 3.52 p=0.005), language (1.59 vs. 1.85 p=0.019) and abstraction (1.18 vs. 1.41 p=0.005) domains. Conclusions The prevalence of cognitive impairment is higher in patients with atrial fibrillation. Atrial fibrillation may have an impact on the most complex cognitive functions as visuospatial/executive, language and abstraction. Acknowledgement/Funding Funding for the study was provided by the Hungarian Academy of Science, contract nr. 0346/26.02.2016.

Objectives: To describe tobacco smoking habits, attitudes, second-hand smoke exposure, and training in cessation counselling at the University of Medicine Pharmacy, Sciences and Technology of Târgu-Mureș (UMPSTTM), as baseline data for the first Romanian university to implement a Smoke Free University Project.Methods: A cross-sectional survey was administered in 2014 among dental students at UMPSTTM to explore their smoking habits, attitudes toward smoking and tobacco control policies, exposure to second-hand smoke, interest in quitting, and their knowledge about cessation counselling. We used core questions of the Global Health Professions Student Survey (GHPSS) and added specific items related to the Smoke Free University Project. Data were analysed by SPSS v22 software. We compared our results with those of the GHPSS Survey.Results: 581 dental students, 73.1% of the target population (n=795), completed the questionnaire. 38.7% were current smokers. Approximately 1 in 5 (22.6%) current smokers admitted smoking inside university buildings, although 80.7% were aware of the smoking ban. 44.2% of current smokers plan to quit smoking. Nearly half of the students (48.9%) were exposed to secondhand smoke in their current homes, 78.1% in public places and 33.3% inside the university buildings. Only 21.0% of all participants received any formal training on how to help future patients quit.Conclusions: Tobacco use prevalence was higher among future dentists than in the majority of respondents to the GHPSS. Changes in dental school education are needed to promote personal smoking cessation, as well as to educate dentists on how to support their future patients quitting.

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Objective:Decreased heart rate variability (HRV) reflecting autonomic nervous dysfunction has been associated with increased mortality in cardiovascular diseases. Less is known about the relationship between HRV and hypertension associated cognitive impairment. The study aimed to compare HRV parameters in well-controlled hypertensive patients with and without cognitive dysfunction, as marker of functional brain damage caused by hypertension.Design and method:Data about 226 hypertensive patients were obtained, 53% males, between 37 and 98 years (mean age 66 years ± 10). The mean blood pressure was 135/81 mmHg (±19/11 mmHg) (under hypertensive medication). Cognitive abilities were measured with the multi-domain Montreal Cognitive Assessment questionnaire (MoCA) defining cognitive decline below 24 points. All patients had 24- hour Holter monitoring. Time domain [pNN(50), NN(50) SDNN, rMSSD] and the LF/HF frequency domain HRV parameters were analyzed in patients with normal and impaired cognition, and in different cognitive domains with the IBM SPSS v20 software.Results:Cognitive dysfunction was present in 63.73% of the studied group. Time domain parameters pNN(50), NN(50) and r MSSD were significantly higher in patients with altered cognition (p = 0.002, p = 0.001, p = 0.02). Frequency domain HF was also significantly higher in this group (p = 0.03). Male individuals had significantly higher LF/HF ratio (men 1.08% vs. women 0.97%, p = 0.006). Patients with hypertension grade II had higher LF/HF ratio compared to grade III (1.069 vs. 0.98%, p = 0.01). Analyzes of cognitive domains in the total study group revealed low SDNN, rMSSD values in language, abstraction domains, with statistical significance in the domains of visuospatial-executive (SDNN p = 0.013, rMSSD p = 0.001) and attention (SDNN p = 0.044). Higher LF/HF ratio was found in all cognitive domains, excepting attention, with statistical difference in delayed recall (p = 0.015).Conclusions:Our data suggest a gender difference regarding sympathovagal balance in hypertensive patients with enhanced sympathetic activity in males. Although higher HRV was observed in cognitively impaired well-controlled hypertensive patients, time domain HRV parameters reflecting impaired autonomic nervous function were related to some specific cognitive domains. Future studies are needed to better understand these findings.