Combined Effects of Cognitive Impairment and Hypertension on Total Mortality in Elderly People: The Kangwha Cohort Study

Abstract

Background: Previous studies have shown links between cognitive impairment and hypertension as well as mortality. However, combined effects of these two conditions on mortality have not been fully explored. Objective: To assess the combined effect of cognitive impairment and hypertension on all-cause mortality among the elderly people. Methods: We followed a cohort of 2,496 residents in Kangwha County, ranging in age from 64 to 101 years as of March 1994, for all-cause mortality for 11.8 years up to December 31, 2005. We calculated hazard ratios (HR) for all-cause mortality by cognitive status and blood pressure using the Cox proportional hazards model after having controlled for confounding factors. Results: 1,189 people (47.6%) died during the 11.8 years of follow-up. The HR associated with severe cognitive impairment increased from 2.15 (95% CI: 1.30, 3.54) for prehypertension over 2.68 (95% CI: 1.60, 4.48) for stage 1 hypertension to 3.60 (95% CI: 1.99, 6.49) for stage 2 hypertension in women. A mortality risk of 3.67 (95% CI: 2.05, 6.57) was observed among men who had both mild cognitive impairment and stage 2 hypertension. Conclusion: Individuals with coexisting cognitive impairment and hypertension are at an increased risk of all-cause mortality compared with those with cognitive impairment or hypertension alone.

Dementia and co‐occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

“…Twenty-nine studies (Kukull et al , 1994; Arfken et al , 1995; Bruce et al , 1995; Gale et al , 1996; Agüero-Torres et al , 1999; Foley et al , 1999; Kammoun et al , 2000; Helmer et al , 2001; Stump et al , 2001; Freels et al , 2002; Ganguli et al , 2002; Feil et al , 2003; Nguyen et al , 2003; Tschanz et al , 2004; Cacciatore et al , 2005; Fitzpatrick et al , 2005; Magaziner et al , 2005; Bursi et al , 2006; Guhne et al , 2006; Llinàs-Regla et al , 2007; Lyketsos et al , 2007; Meerman et al , 2008; Rothman et al , 2008; Zekry et al , 2009; Lavretsky et al , 2010; Wang et al , 2010a; Gombojav et al , 2011; Millán-Calenti et al , 2011; Nikolova et al , 2011) compared mortality rates for persons with multiple CCs and with and without moderate-to-severe cognitive impairment or dementia. Seventeen used community-based samples and 12 used clinic-based samples.…”

“…Fourteen studies (Helmer et al , 2001; Stump et al , 2001; Freels et al , 2002; Feil et al , 2003; Nguyen et al , 2003; Tschanz et al , 2004; Fitzpatrick et al , 2005; Bursi et al , 2006; Guhne et al , 2006; Llinàs-Regla et al , 2007; Meerman et al , 2008; Rothman et al , 2008; Lavretsky et al , 2010; Gombojav et al , 2011) reported the adjusted HR for significant cognitive impairment on risk of mortality (95% CI) ranging from 1.5 (1.1–2.1) (Rothman et al , 2008) to 2.99 (2.53–3.53) (Tschanz et al , 2004); covariates may have included demographics, CCs, and six other frailty criteria (Rothman et al , 2008). The percent attributable risk (PAR%) of death related to dementia diagnosis ranged from 11.8% (Guhne et al , 2006; Llinàs-Regla et al , 2007) to 16.6% (Tschanz et al , 2004).…”

“…Nineteen studies (Agüero-Torres et al , 1998; Zhu et al , 1998; Agüero-Torres et al , 2002; Covinsky et al , 2003; Lyketsos et al , 2005; Magaziner et al , 2005; Lyketsos et al , 2007; Cankurtaran et al , 2008; Rothman et al , 2008; Zekry et al , 2008; Huang et al , 2009; Sousa et al , 2009; Stewart et al , 2009; Zekry et al , 2009; Feng et al , 2010; Wang et al , 2010b; Gombojav et al , 2011; Millán-Calenti et al , 2011; Nikolova et al , 2011) ( N = 37,466) examined the impact of significant cognitive impairment and co-occurring multiple comorbidities on function. Function was typically defined as basic activities of daily living (ADL’s) or instrumental ADL’s (IADLs).…”

Prehypertension Is Not Associated with All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective Studies

“…The large majority of articles were excluded because they were not relevant to the issue we aimed to evaluate. Among the retrieved 38 articles, 13 cohort studies met our inclusion criteria, with 870,678 participants [20]–[32]. Figure 1 provides a diagram of the selection process and reasons for exclusion.…”

Spiritual and religious beliefs: do they matter in the medication adherence behaviour of hypertensive patients?

“…Patients with untreated and uncontrolled hypertension are at an increased risk of developing stroke, heart attack, and kidney or heart failure, which can eventually lead to death. Inadequate control of hypertension has also been associated with cognitive decline in elderly patients [5] resulting in both social and financial burdens [6]. …”