Author + information
- Khalil Murad, MD∗ ( and )
- Dalane W. Kitzman, MD
- ↵∗University of Minnesota, Section of Cardiovascular Diseases, 420 Delaware Street SE, MMC508, Minneapolis, Minnesota 55455
We thank Dr. RuDusky for his interest in our recent report describing the burden of comorbidities and functional and cognitive impairments in elderly patients with incident heart failure (HF) and their impact on outcomes in the Cardiovascular Health Study (1). Our purpose was to use this established, National Institutes of Health–funded population database to provide a detailed, comprehensive examination of the impact of patient characteristics in these key domains that have not been traditionally accounted for in HF research. Our data confirmed and significantly extended other emerging data indicating that these patient characteristics may affect outcomes as strongly as or even stronger than (at least in elderly patients) traditional measures such as cardiac anatomy and function.
We appreciate the writer’s comments reiterate evidence in other reports suggesting a relationship between antihypertensive medications and cognitive impairment, mainly rapid recall. However, to our knowledge, this hypothesis has not been tested in patients with HF, in whom, as we showed in our study, cognitive impairment is highly prevalent. We might expect that any potential burden created by antihypertensive medications would be mitigated by their benefit for patients with HF. This hypothesis could be a focus of future studies. The large, multicenter National Institutes of Health–funded SPRINT (Systolic Blood Pressure Intervention Trial), which recently released its preliminary overall results, has an ongoing component (SPRINT-MIND) that is likely to provide the most definitive test to date of the effect of hypertension and its treatment on cognitive function (2).
Dr. RuDusky’s letter seems to misinterpret some findings from our study. We did not find an association between hypertension and mortality in either direction (both unadjusted and adjusted hazard ratios were neutral or not statistically significant). Our study showed that cognitive impairment was associated with increased mortality in both unadjusted and adjusted analysis. The lack of association in analyses adjusting for hypertension or use of antihypertensive drugs would generally exclude hypertension as a confounding factor. We did not test specifically for an association between hypertension or the use of antihypertensive medications and cognitive impairment because this was not pertinent to the study question. We defined hypertension as elevated systolic and/or diastolic blood pressure or active use of blood pressure–lowering medication.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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