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Effect of age stratification on the association between carotid intima-media thickness and cognitive impairment in Chinese hypertensive patients: new insight from the secondary analysis of the China Stroke Primary Prevention Trial (CSPPT)

Hypertension Research volume 44, pages 1505–1514 (2021)Cite this article

Abstract

The current study aimed to explore the association between carotid intima-media thickness (CIMT) and cognitive function assessed by the Mini-Mental State Examination (MMSE) and to examine possible effect modifiers in hypertensive patients. A total of 14,322 hypertensive participants (mean age 64.2 ± 7.4 years; 40.9% male) from the China Stroke Primary Prevention Trial (CSPPT) were included in the final analysis. CIMT was measured by ultrasound, and data were collected at the last follow-up visit; MMSE was used to evaluate cognitive function. Nonparametric smoothing plots, multivariate linear regression analysis, subgroup analyses and interaction testing were performed to examine the relationship between the CIMI and cognitive function and effect modification. The mean CIMT was 0.74 ± 0.11 mm, and the mean MMSE score was 23.5 ± 4.8. There was a significant interaction (P interaction < 0.05) in both male and female populations stratified by age (<60 vs. ≥60 years), and higher CIMT was significantly associated with decreased MMSE scores only in participants aged ≥60 years (male: β = −2.29, 95% CI −3.23 to −1.36; female: β = −1.96, 95% CI −2.97 to −0.95). Males with abnormal HDL-C showed a stronger negative association (β = −3.16, 95% CI −4.85 to −1.47) than those with normal HDL-C (normal vs. abnormal, P for interaction = 0.004). We observed that increased CIMT was significantly associated with cognitive impairment in the hypertensive population, especially among individuals with an age greater than 60 years and HDL-C deficiency. Overall, upon diagnosis of hypertension, treatment should start at the earliest opportunity to prevent end-organ damage and cognitive decline.

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Acknowledgements

We are very grateful to all participants for their contributions to the China Stroke Primary Prevention Trial (CSPPT).

Funding

The study was supported by funding from the following: the Jiangxi Outstanding Person Foundation (grant number 20192BCBL23024); the National Natural Science Foundation of China (81960074, 81730019); the National Key Research and Development Program (2016YFE0205400, 2018ZX09739, 2018ZX09301034003); Key R&D Projects, Jiangxi (20203BBGL73173); and the Health Commission of Jiangxi Province Foundation (202130440).

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Authors and Affiliations

  1. Department of Cardiovascular, Nanchang University Second Affiliated Hospital, Nanchang, China

    Junpei Li, Ping Li, Huihui Bao, Yanqing Wu, Xiao Huang & Xiaoshu Cheng

  2. People’s Hospital of Pingxiang, Pingxiang, China

    Ling Guo

  3. Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China

    Lishun Liu, Yun Song & Xiping Xu

  4. Shenzhen Evergreen Medical Institute, Shenzhen, China

    Chengzhang Liu & Binyan Wang

  5. State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China

    Lijing Ye

  6. National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Institute of Nephrology, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Yun Song, Xianhui Qin & Xiping Xu

  7. Institute of Biomedicine, Anhui Medical University, Hefei, China

    Genfu Tang & Binyan Wang

  8. Department of Cardiology, Peking University First Hospital, Beijing, China

    Yan Zhang, Jianping Li & Yong Huo

  9. Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Xiaobin Wang

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Li, J., Guo, L., Liu, L. et al. Effect of age stratification on the association between carotid intima-media thickness and cognitive impairment in Chinese hypertensive patients: new insight from the secondary analysis of the China Stroke Primary Prevention Trial (CSPPT). Hypertens Res 44, 1505–1514 (2021). https://doi.org/10.1038/s41440-021-00743-w

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