Cognitive impairment and functional state of the vascular wall in middle-aged men with arterial hypertension

   Objective: to study cognitive functions and the functional state of the vascular wall of the main arteries and microcirculation of the skin in middle-aged men with arterial hypertension (AH).

   Material and methods. Two hundred middle-aged men were studied. Neuropsychological examination and assessment of the emotional-affective sphere were carried out using standard methods. Vascular examination was performed using laser Doppler flowmetry (LDF), photoplethysmography (PPG), applanation tonometry (AT), and flow-dependent vasodilation (FDV) of the brachial artery (BA). Magnetic resonance imaging (MRI) was used to visualise changes in the brain.

   Results. Based on medical history data and office blood pressure (BP) measurements, two groups were identified: 108 men with AH (median age 51.0 [50.0; 51.0] years) and 92 without AH (median age 51.0 [50.0; 52.0] years). According to BP data, men with AH had higher arterial stiffness indices. According to PPG data, the calculated augmentation index (Alp75) was 6.8 % in the group of men with AH and 1.7 % in normotensive men (p < 0.05), the reflectivity index (RI) was 32.5 % and 29.2 % (p < 0.05), respectively, and the central systolic blood pressure in the proximal aorta and brachiocephalic arteries (Spa) was 134.5 and 119.5 mm Hg (p<0.0001), respectively; at the same time, the saturation index (SpO₂) was higher in men without AH – 94.9 % vs. 94.4 % in men with AH (p < 0.05). According to LDF data, no significant intergroup differences were found at the level of precapillary arterioles. According to FDV BA data, men with AH more often had vasodilator endothelial dysfunction (df = 1; χ² = 6.19; p < 0.05). According to the results of neuropsychological testing, men with AH had lower Mini-mental State
Examination scores (28.5 vs. 29 in men without AH; p < 0.05) and on the Benton Visual Retention Test (13 vs. 14 in men without AH; p < 0.05). According to brain MRI data, men with AH had grade I Fazekas scale white matter hyperintensity in 45 % of cases and grade II in 21 %. Also, among men with AH, enlargement of the cerebrospinal fluid spaces was significantly more common (df = 1; χ² = 4.8; p < 0.05).

   Conclusion. The first comprehensive study of the functional state of the vascular wall of the main arteries, skin microvessels and cognitive function in middle-aged men demonstrates greater stiffness of large arteries, indicating higher vascular stiffness and smooth muscle cell tone in terminal muscle arteries and distributive arterioles in men with hypertension than in men with normal blood pressure. Endothelial vasodilator dysfunction is more common among men with AH. Men with AH also have lower cognitive scores, mainly in the domain of visual memory.

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