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In spite of the fact that hypertension stand out as the main vascular risk factor for developing dementia, it is essential to acknowledge the presence of other risk factors, both vascular and non-vascular that contribute to increase this risk. This study stratified the dementia risk using CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) dementia risk score in a sample of 1279 hypertensive patients from the Heart-Brain Study in Argentina and to observed the association between the risk factors include in the CAIDE score and the current cognitive status. The average age of the sample was 60.2 ± 13.5 years (71% female) and the average years of education was 9.9 ± 5.1 years. To assess the current cognitive status, we used the Mini-mental test (MMSE), the clock drawing test (CDT) and Mini-Boston test. According to CAIDE score ( ≥9 points) the risk of dementia was 40.4% in the total sample and 28.1% in the middle-life hypertensive patients (between 47 to 53 years). An inverse association was observed between CAIDE score and the results of current cognitive tests (MMSE = R2 0.9128, p < 0.0001; CDT = R2 0.9215, p < 0.0001 y Mini-Boston= R2 0.829, p < 0.0001). The CAIDE score can predict the risk of dementia in hypertensive patients and its result was associated with the current cognitive status (result of cognitive tests).

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Introduction: The arterial hypertension cause brain vascular damage (white matter lesion) and the burden and progression determine their cognitive consequences. Therefore, arterial hypertension is considered the main modifiable vascular risk factor for cognitive impairment and dementia. Therefore, the aim of the current study was to evaluate the results of cognitive tests in a sample of hypertensive patients and to establish possible associations with structural brain lesions (atrophy, white matter lesions) identified by magnetic resonance imaging Methods: Were included 70 hypertensive patients from Heart-Brain study in Argentina with magnetic resonance imaging and cognitive test. Fazekas scale and the Global Cortical Atrophy were used to quantify the white matter lesions and the brain atrophy, respectively. The Mini-Mental Status Examination, Clock Drawing test and Mini-Boston Naming test were used to evaluate the cognitive status. Results: average age 69.7 ± 10.6 years, 55.7% female). Based on the linear regression analysis, Fazekas scale and cognitive tests were inversely associated. For each grade of increase in Fazekas scale, the clock drawing test (Coef -0.56, CI 95% -1.01 -0.10, p=0.01) and the Mini-mental Status Examination (Coef -0.7, CI 95% -1.27 -0.13, p=0.01) scores decreased. The subcortical atrophy was significantly associated with the clock drawing test (OR 3.29, CI 95% 1.25-8.63; p=0.016). Conclusion: The cognitive tests, particularly the clock drawing test could be used (in the clinical routine practice) as "subrrogate" of the brain structural hypertension-mediated damage.

Introducción: La hipertensión arterial causa daño vascular cerebral (lesiones de sustancia blanca) y su carga y progresión determinan las consecuencias cognitivas. Así, la hipertensión es considerada el principal factor de riesgo vascular modificable para desarrollar deterioro cognitivo y demencia. Por lo tanto el objetivo de la presente investigación fue evaluar el resultado de los test cognitivos en una muestra de pacientes hipertensos y establecer las posibles asociaciones con las lesiones estructurales del cerebro (atrofia, lesiones de sustancia blanca) identificadas mediante resonancia magnética. Métodos: Se incluyeron 70 pacientes hipertensos pertenecientes al estudio Corazón-Cerebro en Argentina a los que se les realizó resonancia magnética y evaluación cognitiva. Se utilizaron las escalas de Fazekas y la Global Cortico Atrophy para evaluar las lesiones de sustancia blanca y la atrofia cerebral, respectivamente y el Mini-mental test, el test del reloj y el test de denominación Mini-Boston para conocer el estatus cognitivo. Resultados: Edad promedio 69.7 ± 10.6 años, 55.7% mujeres. Basados en el análisis de regresión lineal, la escala de Fazekas se asoció en forma inversa con los test cognitivos. Por cada punto de aumento en la escala de Fazekas el puntaje del test del reloj descendió -0.56 (IC 95% -1.01 -0.10, p=0.01) y el Mini-mental test -0.7 (IC95% -1.27 -0.13, p=0.01). La atrofia subcortical se asoció en forma inversa solo con el test del reloj (OR 3.29, IC 95% 1.25-8.63; p=0.016). Conclusión: Los test cognitivos, en especial el test del reloj, podrían ser utilizados, en la práctica clínica asistencial, como un subrogado del daño estructural del cerebro mediado por la hipertensión arterial.

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INTRODUCTION: Hypertension is the main cause of cognitive impairment and the executive dysfunction the most com- mon cognitive domain affected. The aims of this research have been to characterize the cognitive profiles (s) in hypertensive patients and to identify the most usefulness Test (s) in the routine clinical practice to identify them. METHODS: We assessed the cognitive status in 69 hypertensive patients who were administered a battery of cognitive Tests that included the MMSE, the Mini-Boston Naming Test, verbal fluency and the Clock drawing Test. RESULTS: The average of the sample was 72.2±10.1 years. The Clock-drawing Test and the Mini-Boston Naming Test differentiated 3 cognitive profiles: no cognitive impairment, minor cognitive disorder and major cognitive disorder. A strong association was observed between the semantic (0.87) and executive (0.75) components of the Clock-drawing Test with the Mini-Boston Naming Test (0.96). The analysis of clusters and switchings in the verbal fluency Test differentiated the severe forms of cognitive impairment. CONCLUSION: The results obtained confirm the value of the Clock-drawing Test to identify the different cognitive profiles in hypertensive patients, becoming a valid screening test to be used in routine clinical practice and a potential biomarker of cognitive dysfunction in hypertensive patients.

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INTRODUCTION: The COVID-19 pandemic and the sanitary measures implemented had an impact on the mental health of the most vulnerable populations. AIMS: To know the prevalence of anxiety and depression in patients with cardiovascular disease and/or vascular risk factors after the end of quarantine and compare it with the prevalence during quarantine and before the COVID-19 pandemic. METHODS: An online questionnaire was sent 150 days after the quarantine ended. The Hospital Anxiety Depression (HAD) scale was used and clinical and demographic data were recorded. The results were compared with samples obtained during quarantine and the EPICA study conducted in 2016 before the COVID-19 pandemic. RESULTS: The samples included 1076, 3542 and 1035 patients respectively. The prevalence of anxiety fluctuated but did not change (20.8%, 13.5% and 21% respectively). Depression increased its prevalence (9.8%, 16.7% and 19.7% respectively). Depression was associated with coronary heart disease and risk behaviors (cigarette smoking and sedentary lifestyle). CONCLUSION: Depression doubled its prevalence during the COVID-19 pandemic in patients with cardiovascular disease and/or vascular risk factors. The effects of the pandemic appear to extend beyond the duration of the quarantine.

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All the components of the classic renin-angiotensin system (RAS) have been identified in the brain. Today, the RAS is considered to be composed mainly of two axes: the pressor axis, represented by angiotensin (Ang) II/angiotensin-converting enzyme/AT1 receptors, and the depressor and protective one, represented by Ang-(1-7)/ angiotensin-converting enzyme 2/Mas receptors. Although the RAS exerts a pivotal role on electrolyte homeostasis and blood pressure regulation, their components are also implicated in higher brain functions, including cognition, memory, anxiety and depression, and several neurological disorders. Overactivity of the pressor axis of the RAS has been implicated in stroke and several brain disorders, such as cognitive impairment, dementia, and Alzheimer or Parkinson's disease. The present review is focused on the role of the protective axis of the RAS in brain disorders beyond its effects on blood pressure regulation. Furthermore, the use of drugs targeting centrally RAS and its beneficial effects on brain disorders are also discussed.

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Introducción: La hipertensión arterial es el principal factor de riesgo para enfermedad y muerte cardiovascular. Su prevalencia va en aumento, lo cual hace necesario conocer los datos actualizados en la Argentina. Objetivo: Evaluar la prevalencia, el conocimiento, el tratamiento y el control de la hipertensión arterial en la Argentina. Material y métodos: Estudio de corte transversal que incluyó individuos ≥ 18 años de 25 ciudades argentinas. Los participantes fueron encuestados y se midió la presión arterial con presurómetros automáticos validados. Resultados: Se encuestaron 5.931 individuos, con una edad promedio de 43,5 ± 17,1 años. La prevalencia de hipertensión arterial fue del 36,3% (IC 95% 35,1-37,6), siendo mayor en varones (43,7% vs. 30,4%; p < 0,0001). La prevalencia aumentó con la edad en ambos sexos. El 38,8% de los hipertensos desconocían su enfermedad y el 5,7% la conocían pero no recibían tratamiento. El 55,5% estaban tratados y solo el 24,2% se encontraban controlados, observándose más control en las mujeres. El 73,4% de los hipertensos tratados recibían monoterapia y solo el 43,6% estaban controlados. Los pacientes adherentes al tratamiento tuvieron mejor control de la presión arterial que los no adherentes (46,9% vs. 40,1%; p = 0,01). Conclusiones: La prevalencia de hipertensión arterial en la Argentina es del 36,3%, en coincidencia con los reportes de la Organización Mundial de la Salud para la región. El 38,8% de los participantes desconocían su enfermedad. La mitad de los hipertensos recibían tratamiento farmacológico y solo la cuarta parte estaban controlados. Tres de cada cuatro pacientes tratados recibían monoterapia. El control de la presión arterial se relacionó con mejor adherencia al tratamiento.

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The aim of this study was to investigate the cognitive state in women and its relation to menopause and hypertension (HTN). The authors included 1034 women aged 47.13±15.71 years. The prevalence of HTN was 47.1%, with 67.8% of patients treated and 48.6% controlled. Cognitive impairment was higher among hypertensive menopausal (mini-Boston Naming Test: 7.4±3.1 vs 8.5±2.4, P<.001; Clock-Drawing Test: 5.2±2 vs 5.6±1.6, P<.01). Using logistic regression adjusted by age and education level, statistical differences were found in the results from the mini-Boston Naming Test between menopausal hypertensive vs menopausal normotensive women (odds ratio, 1.48; 95% confidence interval, 1.06-2.07; P=.021), and no difference between nonmenopausal hypertensive vs menopausal normotensive women (odds ratio, 0.89; 95% confidence interval, 0.51-1.57; P=.697). The P interaction between both groups was significant (P=.038). The possibility of alteration in cortical functions in menopausal hypertensive woman showed a relative increment of 48% (P=.021). The association between HTN and menopause increases the possibility of compromising the semantic memory by 50%.

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Vascular risk factors are shared by heart and brain. Vascular brain injury (small vessel disease, stroke) alone or combined with neurodegenerative pathology (ß-amyloid depositions) brings about either cognitive decline and vascular dementia or Alzheimer's disease. Long-term exposure to vascular risk factors precedes the onset of neurocognitive diseases by one or two decades. Early detection and control of modifiable vascular risk factors seem to be the only current strategies to prevent cognitive impairment and dementia.

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La acumulación de amiloide, la edad y la enfermedad vascular son los principales factores de riesgo para desarrollar una demencia. Existe un interjuego entre los factores genéticos y vasculares para desarrollar la enfermedad de Alzheimer de inicio tardío. La activación sostenida del sistema renina Angiotensina parece ocupar un papel destacado en la fisiopatología de las demencias incluyendo la enfermedad de Alzheimer. El tratamiento antihipertensivo con inhibidores de la enzima de conversión de Angiotensina tanto como el bloqueo de los receptores de la Angiotensina II, parecen superiores sobre otros fármacos en la prevención de las demencias

The age, aggregation of amyloid, and vascular disease are major risk factors for developing dementia. There is interplay between genetic and vascular factors to develop late-onset Alzheimer's disease. Sustained the renin angiotensin system activation seems to occupy an important role in the pathophysiology of dementia including Alzheimer's disease. Antihypertensive treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockade, seem superior over other drugs in the prevention of dementia

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La acumulación de amiloide, la edad y la enfermedad vascular son los principales factores de riesgo para desarrollar una demencia. Existe un interjuego entre los factores genéticos y vasculares para desarrollar la enfermedad de Alzheimer de inicio tardío. La activación sostenida del sistema renina Angiotensina parece ocupar un papel destacado en la fisiopatología de las demencias incluyendo la enfermedad de Alzheimer. El tratamiento antihipertensivo con inhibidores de la enzima de conversión de Angiotensina tanto como el bloqueo de los receptores de la Angiotensina II, parecen superiores sobre otros fármacos en la prevención de las demencias (AU)

The age, aggregation of amyloid, and vascular disease are major risk factors for developing dementia. There is interplay between genetic and vascular factors to develop late-onset Alzheimers disease. Sustained the renin angiotensin system activation seems to occupy an important role in the pathophysiology of dementia including Alzheimers disease. Antihypertensive treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockade, seem superior over other drugs in the prevention of dementia (AU)

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