TY - JOUR
T1 - Left ventricular hypertrophy in association with cognitive impairment
T2 - A systematic review and meta-analysis
AU - Georgakis, Marios K.
AU - Synetos, Andreas
AU - Mihas, Constantinos
AU - Karalexi, Maria A.
AU - Tousoulis, Dimitrios
AU - Seshadri, Sudha
AU - Petridou, Eleni Th
N1 - Funding Information:
We are thankful to the authors of the studies that provided the primary data or analyses based on their data. Specifically, we would like to acknowledge the contributions made by Professor Antonio Muscari and Dr Pilar Delgado Martinez for sending the results of a requested re-analysis of their data, Professor Helen Triantafyllidi and Dr Gulay Asci for providing the raw data of their studies, and Professor Alexa Beiser for conducting a re-analysis of the data from the Framingham Offspring Study (the data collection for the Framingham Study was funded by contracts from the National Heart, Lung and Blood Institute [N01-HC-25195; HHSN268201500001l] and by grants obtained from the National Institute on Aging [AG008122] and the National Institute for Neurological Disorders and Stroke [NS017950]). We would also like to thank all the authors who replied to the request for additional data, as detailed in the Supplementary Table 2. We thank Mr Nikolaos Dimitriou for participating in the selection of studies, and lastly, we thank Dr Prodromos Kanavidis for developing the electronic platform for retrieving the abstracts for blind screening by the reviewers.
Publisher Copyright:
© 2017 The Japanese Society of Hypertension. All rights reserved.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Left ventricular hypertrophy (LVH) is a marker of prolonged exposure to high blood pressure and a predictor of cardiovascular disease risk. The objective of the current study was to investigate its association with cognitive function. Following standard guidelines, pairs of independent reviewers screened 2359 articles to search for studies that addressed the research question, extracted data and evaluated the quality of the studies using the Newcastle-Ottawa scale; authors were contacted for additional data. A random-effects meta-analysis and a meta-regression analysis were performed. Eighteen eligible studies using various methodologies and of varying quality were identified. However, both cross-sectional and prospective studies were indicative of a positive association between LVH and cognitive impairment or cognitive performance and decline in both population-based and patient-based subjects. The meta-analysis showed an increased risk of cognitive impairment among subjects with LVH in population-based studies (9 studies; 28 648 subjects; odds ratio (OR): 1.40, 95% confidence interval (CI): 1.18-1.66) and studies exclusively on hypertensive subjects (3 studies; 1262 subjects; OR: 2.14, 95% CI: 1.39-3.30). The effect was stronger when assessing LVH by echocardiography rather than electrocardiogram and was retained in the sensitivity analyses of prospective and highest quality studies and studies adjusting for hypertension or blood pressure levels. No heterogeneity or publication bias was documented, whereas the presence of hypertension seemed to reinforce the reported association, as derived from the meta-regression analysis. There is evidence suggesting an independent association of LVH with cognitive impairment. Because of the highly heterogeneous methodologies, future large prospective studies with clinically defined dementia outcomes are needed to replicate the findings.
AB - Left ventricular hypertrophy (LVH) is a marker of prolonged exposure to high blood pressure and a predictor of cardiovascular disease risk. The objective of the current study was to investigate its association with cognitive function. Following standard guidelines, pairs of independent reviewers screened 2359 articles to search for studies that addressed the research question, extracted data and evaluated the quality of the studies using the Newcastle-Ottawa scale; authors were contacted for additional data. A random-effects meta-analysis and a meta-regression analysis were performed. Eighteen eligible studies using various methodologies and of varying quality were identified. However, both cross-sectional and prospective studies were indicative of a positive association between LVH and cognitive impairment or cognitive performance and decline in both population-based and patient-based subjects. The meta-analysis showed an increased risk of cognitive impairment among subjects with LVH in population-based studies (9 studies; 28 648 subjects; odds ratio (OR): 1.40, 95% confidence interval (CI): 1.18-1.66) and studies exclusively on hypertensive subjects (3 studies; 1262 subjects; OR: 2.14, 95% CI: 1.39-3.30). The effect was stronger when assessing LVH by echocardiography rather than electrocardiogram and was retained in the sensitivity analyses of prospective and highest quality studies and studies adjusting for hypertension or blood pressure levels. No heterogeneity or publication bias was documented, whereas the presence of hypertension seemed to reinforce the reported association, as derived from the meta-regression analysis. There is evidence suggesting an independent association of LVH with cognitive impairment. Because of the highly heterogeneous methodologies, future large prospective studies with clinically defined dementia outcomes are needed to replicate the findings.
KW - cognitive impairment
KW - dementia
KW - hypertension
KW - left ventricular hypertrophy
KW - target organ damage
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U2 - 10.1038/hr.2017.11
DO - 10.1038/hr.2017.11
M3 - Review article
C2 - 28202945
AN - SCOPUS:85019121551
SN - 0916-9636
VL - 40
SP - 696
EP - 709
JO - Hypertension Research
JF - Hypertension Research
IS - 7
ER -