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Left ventricular hypertrophy and incident cognitive impairment in elderly hypertensive patients : hypertension in the very elderly trial
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Xu, Ying, Bouliotis, George, Beckett, Nigel S., Warwick, Jane, Antikainen, Riitta L., Anderson, Craig S., Bulpitt, Christopher J. and Peters, Ruth (2021) Left ventricular hypertrophy and incident cognitive impairment in elderly hypertensive patients : hypertension in the very elderly trial. Alzheimer's & Dementia, 17 (S10). doi:10.1002/alz.055876 ISSN 1552-5260.
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Official URL: https://doi.org/10.1002/alz.055876
Abstract
Background
We assessed whether left ventricular hypertrophy (LVH), as an indicator of hypertensive target organ damage, was associated with subsequent cognitive decline.
Method
We used data collected in the Hypertension in the Very Elderly Trial (HYVET). HYVET was a double-blind placebo-controlled trial of antihypertensives in hypertensive older adults (≥80 years). Trial treatment was not associated with cognitive decline, allowing us to analyze the trial data as a cohort. The baseline characteristics of the analytical sample and those who were excluded due to missing electrocardiography (ECG) values or cognitive outcomes were compared. LVH was assessed using a 12-lead ECG based on Cornell product criterion. The Mini-Mental State Examination (MMSE) was used to assess cognitive function at baseline and annually. A fall in MMSE to ≤24 or an annual fall of ≥three points was defined as cognitive decline. Proportional hazard regression, including a competing risk Fine-Gray model to account for competing outcomes (stroke, heart failure, myocardial infarction, other fatal cardiovascular disease), was used to examine the relationship between baseline LVH and cognitive outcomes. Sensitivity analyses were run in those with baseline MMSE ≥24, considered unlikely to have pre-existing cognitive decline. To evaluate attrition bias, we ran inverse probability weighting (IPW) models.
Result
There were 1944 in the analytical sample, 164 with LVH. Mean follow-up was 3.9 or 4.2 years accounting or not accounting for competing outcomes. The analytical sample differed from those excluded, e.g. they had higher diastolic blood pressures and were more likely to be female (Table 1). LVH was associated with increased risk of 1) cognitive decline (Table 2), hazard ratio (HR)1.44 (95%confidence interval (CI)1.12:1.84), 2) combined cardiovascular events and cognitive decline, HR1.51 (95% CI 1.2:1.91), and 3) cognitive decline using the Fine-Gray model, HR1.41 (95%CI 1.08:1.84). Sensitivity and IPW analyses yielded similar results.
Conclusion
CP criterion defined LVH was associated with an increased risk of cognitive decline in older adults with hypertension. The potential for selection bias and healthy individual bias (trial participants) should be noted. Further work should explore the potential for LVH as an indicator of target organ damage beyond the heart.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | ||||||
Journal or Publication Title: | Alzheimer's & Dementia | ||||||
Publisher: | Wiley | ||||||
ISSN: | 1552-5260 | ||||||
Official Date: | 31 December 2021 | ||||||
Dates: |
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Volume: | 17 | ||||||
Number: | S10 | ||||||
DOI: | 10.1002/alz.055876 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Reuse Statement (publisher, data, author rights): | ** Article version: VoR ** From Crossref journal articles via Jisc Publications Router ** History: epub 31-12-2021. ** Licence for VoR version of this article starting on 31-12-2021: http://onlinelibrary.wiley.com/termsAndConditions#vor | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Description: | Free access |
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