Left Ventricular Mass, Blood Pressure, and Lowered Cognitive Performance in the Framingham Offspring

Abstract

Abstract-The purpose of this study was to determine whether echocardiographic left ventricular mass is related to cognitive performance beyond casual blood pressure adjusting for the influence of other vascular risk factors. We used multivariable regression analyses to relate left ventricular mass assessed at a routine examination (1995)(1996)(1997)(1998) to measures of cognitive ability obtained routinely (1998 -2001) A lthough there is an extensive literature on the association of blood pressure and cognitive performance, little information is available regarding the relationship of left ventricular mass (LVM) to cognition. With regard to blood pressure (BP), many studies have shown that, over a wide range of BP values and with adjustment for hypertensionrelated complications, both systolic and diastolic BP are inversely related to the level of cognitive performance and longitudinal decline in performance. [1][2][3][4][5][6][7][8][9] The most widely accepted mechanism by which high BP reduces cognitive ability is via its effect on brain structure and function. 10 -16 Hypertension is associated with acceleration of atherosclerosis in the large arteries and is associated with medial thickening of the intracerebral vessels leading to cerebral white matter hypoperfusion and ischemic rarefaction. 16 A causal association between higher BP and lower cognition has been suggested because of the observation of a "doseresponse" effect in studies relating BP and cognition. [1][2][3][7][8][9] Both the duration and the magnitude of BP elevation have been related inversely to cognitive performance. 9 However, the use of the duration of hypertension as a marker of the chronic hemodynamic burden posed by high BP is challenged by the lack of precision in identifying the exact date of hypertension onset in epidemiological studies. LVM is strongly associated with long-term BP cross-sectionally 10 and is a predictor of future risk of hypertension in nonhypertensive individuals 11 In addition, LVM is a surrogate marker of cardiovascular target organ damage and is associated with incidence of cardiovascular disease prospectively. [12][13][14][15][16] These findings suggest that LVM, as determined by echocardiography, should relate to levels of cognitive performance in a manner similar to, but not necessarily identical with, BP.Because LVM is a time-integrated correlate of exposure to BP and to other cardiovascular risk factors, it may serve as a marker of the chronicity and the degree of BP elevation and an indicator of long-term burden of vascular risk factors.

Hypertensive organ damage predicts future cognitive performance: A 9‐year follow‐up study in patients with hypertension

“…Our results are in agreement with previous studies that showed associations between cardiac damage and cognitive function 7, 8. However, as these studies did not investigate this association independently of brain damage, these results might be due to a high correlation between hypertensive cardiac damage and brain damage.…”

“…These imaging markers of cSVD are strongly associated with cognitive function 3, 4, 5, 6. Other types of hypertensive organ damage, such as cardiac and renal damages, have also been linked to lower cognitive function or increased risk of cognitive impairment 7, 8, 9, 10, 11…”

Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults

“…Although this observation is consistent with some prior work,9, 10 the remaining null cognitive results contrast with literature reporting cognitive associations with LVH8 or increased LV mass index3, 28 in aging cohorts that include dementia cases. Although increased LV mass index is an early marker of pathologic LV remodeling, it may not strongly correspond with subtle cognitive changes in cognitively normal individuals or elders with only mild prodromal symptoms of dementia, such as those participants studied here.…”

“…Although increased LV mass index is an early marker of pathologic LV remodeling, it may not strongly correspond with subtle cognitive changes in cognitively normal individuals or elders with only mild prodromal symptoms of dementia, such as those participants studied here. Furthermore, prior work has shown that the association between increased LV mass index and cognition is attenuated when other cardiovascular risk factors are adjusted for,3, 8, 9, 10 as was done here with the inclusion of a vascular risk score.…”

“…Given prior research linking overt LVH to cognitive impairment3 and white matter lesions,2 we hypothesized that higher LV mass index would correlate with compromised white matter microstructure on DTI and worse neuropsychological performance (especially memory) 10. Secondarily, we tested whether associations differed by cognitive diagnosis.…”