Abstract
Previous research indicates that blood pressure may impact a variety of cognitive functions, including short-term memory, abstract reasoning, visual-spatial abilities, and attention (Boller, Vrtunski, Mack, & Kim, 1977; Elias, Robbins, Schultz, & Pierce, 1990; Franceschi, Tancredi, Smirne, Mercinelli, & Canal, 1982; Mazzucchiet al., 1986). However, studies which have assessed the cognitive functioning of hypertensive adults have offered conflicting results, particularly when hypertension levels were in the mild range (e.g., Bolleret al., 1977; Eliaset al., 1990; Elias, Wolf, D'Agostino, Cobb, & White, 1993; Farmeret al., 1987, 1990; Franceschiet al., 1982; Pérez-Stable, Coates, Halliday, Gardiner, & Hauck, 1992; Schmidtet al., 1991; Waldstein, Ryan, Manuck, Parkinson, & Bromet, 1991). A number of factors may contribute to the inconsistent findings in this area. Researchers have employed a wide range of neuropsychological instruments to assess varying domains of cognitive function. Sample sizes in some studies have been too small to ensure sufficient power. Finally, studies have employed varying methodological control over potential confounding factors such as concurrent medical conditions, alcohol abuse, psychiatric disorders, or antihypertensive medication. This study compared male veterans with blood pressures in the mildly hypertensive range (n=166) to normotensive veterans (n=176) on neuropsychological measures of verbal fluency, visual-spatial ability, verbal and visual memory, dexterity, attention, and executive functions. Results revealed that, after controlling for differences in education and income, there was no relationship between mild hypertension and combined measures of cognitive performance. The present findings suggest that mild hypertension alone has little effect on cognitive function in adults.
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References
Benton, A. L., & Hamsher, K. deS. (1976).Manual for the multilingual aphasia examination. Iowa City: University of Iowa.
Berg, E. A. (1948). A simple objective technique for measuring flexibility in thinking.Journal of General Psychology, 39 15–22.
Blumenthal, J. A., Madden, D. J., Pierce, T. W., Siegel, W. C., & Appelbaum, M. (1993). Hypertension affects neurobehavioral functioning.Psychosomatic Medicine, 55 44–50.
Boller, F., Vrtunski, B., Mack, J. L., & Kim, Y. (1977). Neuropsychological correlates of hypertension.Archives of Neurology, 34 701–705.
Bornstein, R. A. (1986). Consistency of intermanual discrepancies in normal and unilateral brain lesion patients.Journal of Consulting and Clinical Psychology, 54(5), 719–723.
Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (1987).Manual for the California Verbal Learning Test. San Antonio, TX: Psychological Corp.
Delis, D. C., Cullum, C. M., Butters, N., Cairns, P., & Prifitera, A. (1988). Wechsler Memory Scale-Revised and California Verbal Learning Test: Convergence and divergence.The Clinical Neuropsychologist, 2(2), 188–196.
Elias, M. F., & Elias, P. K. (1993). Hypertension affects neurobehavioral functioning: So what's new?Psychosomatic Medicine, 55 51–54.
Elias, M. F., Robbins, M. A., Schultz, N. R., Jr., & Streeten, D. H. P. (1986). A longitudinal study of neuropsychological test performance for hypertensive and normotensive adults: Initial findings.Journal of Gerontology, 1 503–505.
Elias, M. F., Robbins, M. A., Schultz, N. R., Streeten, D. H. P., & Elias, P. K. (1987). Clinical significance of cognitive performance by hypertensive patients.Hypertension, 9 192–197.
Elias, M. F. Robbins, M. A. Schultz, N. R., Jr., & Pierce, T. W. (1990). Is blood pressure an important variable in research on aging and neuropsychological test performance?Journal of Gerontology: Psychological Sciences, 45(4), 128–135.
Elias, M. F., Wolf, P. A., D'Agostino, R. B., Cobb, J., & White, L. R. (1993). Untreated blood pressure level is inversely related to cognitive functioning: The Framingham Study.American Journal of Epidemiology, 138 353–364.
Farmer, M. E., White, L. R., Abbott, R. D., Kittner, S. J., Kaplan, E., Wolz, M. M., Brody, J. A., & Wolf, P. A. (1987). Blood pressure and cognitive performance.American Journal of Epidemiology, 1103–1114.
Farmer, M. E., Kittner, S. J., Abbott, R. D., Wolz, M. M., Wolf, P. A., & White, L. R. (1990). Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: The Framingham Study.Journal of Clinical Epidemiology, 43(5), 475–480.
Franceschi, M., Tancredi, O., Smirne, S., Mercinelli, A., & Canal, N. (1982). Cognitive processes in hypertension.Hypertension, 4 226–229.
Goldman, H., Kleinman, K. M., Snow, M. Y., Bidus, D. R., & Korol, B. (1974). Correlation of diastolic blood pressure and signs of cognitive dysfunction in essential hypertension.Diseases of the Nervous System, 35 571–572.
Goldman, H., Kleinman, K. M., Snow, M. Y., Bidus, D. R., & Korol, B. (1975). Relationship between essential hypertension and cognitive functioning: Effects of biofeedback.Psychophysiology, 569–573.
Gronwall, D. M. A., & Sampson, H. (1974).The psychological effects of concussion. Auckland: Auckland University Press.
Hair, J. F., Jr., Anderson, R. E., Tatham, R. L., & Black, W. C. (1992).Multivariate data analysis (3rd ed.). New York: Macmillan.
Heaton, R. K. (1981).Wisconsin Card Sorting Test manual. FL: Psychological Assessment Resources.
Jarvis, P. E., & Barth, J. T. (1984).Halstead-Reitan test battery: An interpretive guide. FL: Psychological Assessment Resources.
Kleinman, K. M., Goldman, H., Snow, M. Y., & Korol, B. (1977). Relationship between essential hypertension and cognitive functioning. II. Effects of biofeedback training generalize to non-laboratory environment.Psychophysiology, 14 192–197.
Klove, H. (1963). Clinical neuropsychology. In F. M. Forster (Ed.).,The medical clinics of North America. New York: Saunders.
Lezak, M. D. (1983).Neuropsychological assessment (2nd ed.). New York: Oxford University Press.
Llabre, M. M., Ironson, G. H., Spitzer, S. B., Gellman, M. D., Weidler, D. J., & Schneiderman, N. (1988). How many blood pressure measurements are enough? An application of generalizability theory to the study of blood pressure reliability.Psychophysiology, 25(1), 97–106.
Madden, D. J., & Blumenthal, J. A. (1989). Slowing of memory-search performance in men with mild hypertension.Health Psychology, 8 131–142.
Matthews, C. G., & Haaland, K. Y. (1979). The effect of symptom duration on cognitive and motor performance in Parkinsonism.Neurology, 29 951–956.
Mazzucchi, A., Mutti, A., Poletti, A., Ravanetti, C., Novarini, A., & Parma, M. (1986). Neuropsychological deficits in arterial hypertension.Acta Neurologica Scandinavia, 73 619–627.
Miller, R. E., Shapiro, A. P., King, H. E., Ginchereau, E. H., & Hosutt, J. A. (1984). Effect of antihypertensive treatment on the behavioral consequences of elevated blood pressure.Hypertension, 6 202–208.
Montague, E. K., Williams, H. L., Lubin, A., & Gieseking, C. F. (1957). Army tests for assessment of intellectual deficit.U.S. Armed Forces Medical Journal, 8 883–892.
Norusis, M. J. (1990).Statistical package for the social sciences: SPSS/PC+ statistics 4.0 for the IBM PC/XT/AT and PS/2. Chicago: SPSS.
Osterrieth, P. A. (1944). Le test de copie d'une figure complexe.Archives de Psychologie, 30 206–356.
Pentz, C. A., Elias, M. F., Wood, W. G., Schultz, N. A., & Dineen, J. (1979). Relationship of age and hypertension to neuropsychological test performance.Experimental Aging Research, 5 351–372.
Pérez-Stable, E. J., Coates, T. J., Halliday, R., Gardiner, P. S., & Hauck, W. W. (1992). The effects of mild diastolic hypertension on the results of tests of cognitive function in adults 22 to 59 years of age.Journal of General Internal Medicine, 7 19–25.
Robbins, M. A., Elias, M. F., Croog, S. H., & Colton, T. (1994). Unmedicated blood pressure levels and quality of life in elderly hypertensive women.Psychosomatic Medicine, 56 251–259.
Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1981). The NIMH Diagnostic Interview Schedule: Its history, characteristics and validity.Archives of General Psychiatry, 38 381–389.
Schmidt, R., Fazekas, F., Offenbacher, H., Lytwyn, H., Blematl, B., Niederkorn, K., Horner, S., Payer, F., & Freidl, W. (1991). Magnetic resonance imaging white matter lesions and cognitive impairment in hypertensive individuals.Archives of Neurology, 48 417–420.
Schultz, N. R., Jr., Dineen, J. T., Elias, M. F., Penz, C. A., & Wood, W. G. (1979). WAIS performance for different age groups of hypertensive and control subjects during the administration of a diuretic.Journal of Gerontology, 34 246–253.
Schultz, N. R., Jr., Elias, M. F., Robbins, M. A., Streeten, D. H. P., & Blakeman, N. (1986). A longitudinal comparison of hypertensives and normotensives on the Wechsler Adult Intelligence Scale: Initial findings.Journal of Gerontology, 41(2), 169–175.
Shapiro, A. P., Miller, R. E., King, H. E., Ginchereau, E. H., & Fitzgibbon, K. (1982). Behavioral consequences of mild hypertension.Hypertension, 4(3), 355–360.
Stevens, J. (1986).Applied multivariate statistics for the social sciences. NJ: Lawrence Erlbaum Associates, Inc.
Streeten, D. H. P. (1980). Introduction: What is hypertension? In M. F. Elias & D. H. P. Streeten (Eds.),Hypertension and cognitive processes (pp. 3–15). Mount Desert, ME: Beech Hill.
Subcommittee of the 1984 Joint National Committee (1985). Hypertension prevalence and the status of awareness, treatment and control in the U.S.Hypertension, 7 457–468.
Tabachnick, B. G., & Fidell, L. S. (1989).Using multivariate statistics (2nd ed.). New York: Harper Collins.
U.S. Department of Health & Human Services, Public Health Service, Centers for Disease Control (1989).Health status of Vietnam veterans, Vols. I–V.
Waldstein, S. R., Manuck, S. B., Ryan, C. M., & Muldoon, M. F. (1991). Neuropsychological correlates of hypertension: Review and methodologic considerations.Psychological Bulletin, 110(3), 451–468.
Waldstein, S. R., Ryan, C. M., Manuck, S. B., Parkinson, D. K., & Bromet, E. J. (1991). Learning and memory function in men with untreated blood pressure elevation.Journal of Consulting and Clinical Psychology, 79 513–517.
Wechsler, D. (1981).Manual for the Wechsler Adult Intelligence Scale—Revised. San Antonio, TX: The Psychological Corp.
Wollam, G. L., & Hall, W. D. (1988). Mild hypertension: The effect of therapy on morbidity and mortality. In G. L. Wollam & W. D. Hall (Eds.),Hypertension Management (pp. 3–66). Chicago: Year Book Medical.
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Grossman, L.R., Zalewski, C. Hypertension and cognitive function. J Clin Psychol Med Settings 2, 233–248 (1995). https://doi.org/10.1007/BF01990879
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DOI: https://doi.org/10.1007/BF01990879