CORRELATION OF COGNITIVE STATUS WITH IMPAIRED SKIN MICROVASCULAR REACTIVITY IN NEWLY DIAGNOSED UNTREATED HYPERTENSIVES

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Objective: Untreated hypertension (HT) in the early midlife is strongly correlated with mild cognitive impairment (MCI) later on, in the elderly. HT is also associated with significant microvascular alterations in several vascular beds including skin. Skin microcirculation has been correlated with microvascular alterations in other beds and has been proposed as a model of generalized microvascular dysfunction. We sought to estimate the prevalence of MCI in newly diagnosed untreated hypertensive patients (UHTs) and compare it to normotensive healthy individuals (NTs). We also investigated possible associations between MCI and parameters of skin microvascular reactivity by using a novel laser technique, namely Laser Speckle Contrast Imaging (LSCI). Design and method: We consecutively enrolled 51 individuals including 31 UHTs and 20 NTs. All patients were free from diabetes mellitus or any cardiovascular disease. Diagnosis of HT was based on conventional office BP and 24h-Ambulatory Blood Pressure Measurement (24h-ABPM) criteria, according to standard guidelines. The Montreal Cognitive Assessment test (MoCA test) was used to assess cognitive function with a score equal to or lower than 26 being suggestive of MCI for all participants. The LSCI technique combined with post-occlusive reactive hyperemia (PORH) protocol was used to assess skin microvascular reactivity. Skin microvascular results are expressed as percentage increase of cutaneous perfusion from baseline to peak condition (base to peak flux, %). Results: Base to peak flux was significantly lower in UHTs compared to NTs (211.0 ± 53.1 vs 154.0 ± 53.0 %, p < 0.01). Although the prevalence of MCI did not differ between UHTs and NTs, there was also a significant positive correlation between the MoCA test score and base to peak flux in the UHTs group (r = 0.491, p = 0.02). Conclusions: Although UHTs did not present impaired cognitive status compared to NTs, they do present impaired skin microvascular reactivity which is strongly correlated with their cognitive status from the very early stages of hypertension. Early and effective treatment of essential hypertension may contribute to the prevention of MCI and the improvement of skin microvascular function in hypertensive patients.

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