Hypotension and cognitive impairment - Selective association in patients with heart failure

Background: Arterial hypotension has been associated with increased risk of dementia in some large prospective studies; and cognitive impairment is co mmon among elderly with left ventricular function. The authors assessed whe ther arterial hypotension might be associated with cognitive impairment amo ng older subjects with heart failure. Methods: This study involved all 13,6 35 patients (of whom 1,583 had heart failure) without cerebrovascular disea se or AD, admitted to 81 Italian academic hospitals in 1995 and 1997. The a ssociation between blood pressure and cognitive impairment (as indicated by a Hodkinson Mental Test score < 7) according to the presence of heart fail ure was assessed by univariate analyses, including linear discriminant anal ysis. This association was also verified by multivariate analyses after str atifying for diagnosis of heart failure. Results: Cognitive impairment was found in 26% of patients with heart failure and in 19% of remaining subject s (Fisher exact p < 0.0001). Blood pressure levels did not differ according to diagnosis of heart failure, but discriminant analysis indicated that sy stolic blood pressure levels below 130 mm Hg predicted cognitive impairment only among participants with heart failure. Among such participants, systo lic blood pressure was associated with cognitive impairment in multiple log istic regression modeling (for 10 mm Hg intervals, OR = 0.78; 95% CI = 0.71 to 0.86). Again, this association was not found among participants without heart failure, Conclusions: Systolic hypotension is selectively associated with cognitive impairment in older patients with heart failure. As early t reatment of cardiac low-output states can reverse cognitive dysfunction, th e routine management of heart failure should include systematic assessment of cognitive performance.