Cognitive impairment leading to
dementia is associated with high prevalence of
hypertension, decreased quality of life and poor prognosis.
Aldosterone is known as a risk factor for cardiovascular and
cerebrovascular diseases. In addition,
mineral corticoid receptors are abundantly expressed in the hippocampus, which plays a pivotal role in cognitive function; however, it has not been determined whether plasma
aldosterone level is associated with
cognitive impairment in patients with
hypertension. We enrolled 68 patients with
essential hypertension and assessed their cardiovascular risk factors, including blood pressure,
hyperlipidemia,
diabetes mellitus,
obesity, smoking, history of
cerebral infarction, renal function, parameters of
inflammation, oxidative stress and
nitric oxide bioavailability, a parameter of cerebral blood flow and carotid plaque by ultrasound examination, plasma
renin activity and plasma
aldosterone concentration (PAC). The mini-mental state examination (MMSE) was used to evaluate cognitive function. The relevance of cardiovascular risk factors and MMSE score was statistically evaluated. Multiple regression analysis showed that age (P < 0.01), PAC (P < 0.01) and history of
cerebral infarction (P < 0.05) were inversely and independently associated with MMSE score.
Mineral corticoid receptor antagonists, including
spironolactone and
eplerenone, increased MMSE score in seven patients with
hypertension, but not in the controls. In conclusion, increased PAC is associated with impaired cognitive function and
mineral corticoid receptor blockade may protect against not only cardiovascular mortality, but also
cognitive impairment in patients with
hypertension.