Assessment of Cognition in Hypertensives and Normotensives: A Comparative P300 Study.

BACKGROUND:  Hypertension is an established risk factor for dementia, and the prevalence of hypertension and dementia is rising. Current tests to diagnose cognitive dysfunction at an early stage lack sensitivity and specificity. Recently event-related potentials (ERPs) have gained much attention in diagnosing cognitive dysfunction and are independent of the education status of the subject. This study was done to find any cognitive deficits in the hypertensive population with electrophysiological evidence, which might open the doors for the need to screen the population at an earlier stage so that the population can be prevented from dementia. METHODS:  Some 31 middle-aged (18-65 years) hypertensives were compared with 31 age, sex, education, and handedness matched normotensives about cognition by neuropsychometric test battery including Hindi Mini-mental Status Examination (HMSE), Hindi Montreal Cognitive Assessment (MoCA), choice reaction time (CRT), and auditory event-related potentials. RESULTS:  Hypertensives and normotensives differed significantly concerning P300 potentials' latency (Fz and Cz P300 latencies: p-value: 0.001), and this change was correlated well with the duration of diastolic blood pressure (BP) (r-value: 0.670). The remaining tests, HMSE, Hindi MoCA, and CRT, were dependent on the education status of the patient. CONCLUSIONS:  The effect of hypertension on cognitive impairment is evident and can be proved early in its pre-clinical stage using ERPs. Early identification can help in specifying high-risk individuals. ERPs have great potential in screening and diagnosing and can also help in assessing cognition as a reliable tool to show the effect of treatments/interventions on cognitive defects.

Concomitant Interstitial Lung Disease With Psoriasis.

Interstitial lung disease is occasionally reported in patients with psoriasis as drug-induced pneumonitis secondary to concomitant use of immunosuppressants in most cases. Although few cases have been reported describing the simultaneous existence of psoriasis and interstitial pneumonia, there are no reports that clearly show their direct association. A 55-year-old male known case of psoriasis and hypertension presented to the emergency department with complaints of pain and weakness of bilateral upper limbs following an episode of seizure and shortness of breath on exertion for one year. Following workup, the patient was diagnosed to have interstitial lung disease. There was no history of any immunosuppressant or use of biologics. So, immune dysfunction triggered by psoriasis might have caused the lung fibrotic changes. Careful monitoring of lung and skin lesions is vital for diagnosing psoriasis-associated pneumonia.

A Comparative Study of Baseline Heart Rate Variability, Sleep Quality, and Oxidative Stress Levels in Hypertensive Versus Normotensive Subjects: A Cross-Sectional Study.

OBJECTIVES: To understand sleep quality, oxidative stress levels, and heart rate variability (HRV) in subjects with hypertension. This study aims to create baseline data in hypertensive subjects to research the possibility of further estimating the risk of developing cardiovascular mortality and morbidity in a patient with hypertension. DESIGN AND METHODS: This analytical cross-sectional study, encompassing 128 study subjects of both genders, with 64 hypertensive subjects, analyse the co-relation of sleep quality, malondialdehyde, and heart rate variability in hypertensive and normotensive subjects. The study was done in a tertiary teaching institute in northern India for 14 months. Descriptive statistics were used, and the independent t-test, Mann-Whitney U test, and Chi-square were used to find the association among the variables. Linear regression was used to estimate the effect of blood pressure on malondialdehyde levels. RESULTS: Subjects with hypertension were found to have poor sleep quality (Global PSQI score ≥5, p=0.0001) and an increased malondialdehyde level (0.30303±0.17193 µM/L, p=0.0001). The hypertensive subjects were found to have lower parasympathetic activity as indicated by low high frequency (2.79463±473.220280; p=0.0001) and increased sympathetic activity; low frequency/high frequency (2.29823±2.792441; p=0.0001). Multivariate linear regression predicts that with one unit increase in systolic blood pressure, the malondialdehyde level increases by 0.006 units (p=0.002; 95% CI). CONCLUSION: Among the hypertensive group, there is significantly increased oxidative stress level, poor quality of sleep, and increased sympathetic activity, thereby predisposing the subjects to increased risk of cardiac morbidity and mortality.