Cognitive Disorders in Patients with Hypertension: Are There Gender Differences?

  • Viktoriia Krotova Dnipropetrovsk Medical Academy
  • Oleksandra Rosytska Dnipro State Medical University
  • Tetyana Khomazyuk
Keywords: hypertension, cognitive disorders, neuropsychological tests, quality of life, gender characteristics, autonomic (vegetative) index, blood pressure


Background: Given the profound differences between women and men, there is a need to study gender as a vital variable and factor in blood pressure regulation, control, and treatment. The level of anxiety and depression, which significantly affect the psychological characteristics and patients' quality of life, and the status of the autonomic nervous system represent a rather significant layer of hypertension problems due to its specificity, accumulating its medical, social, gender, and humanitarian aspects, which are related to sexual characteristics.

Material and Methods: The study results are based on the data of a comprehensive examination of 185 working patients with controlled hypertension (H) stage II. According to the neuro-psychological testing on MMSE, МоСА and Life Quality scales, 157 people with various severity cognitive disorders (CD) were found. There were 87 (55.4 %) women and 70 (44.6 %) men among them, and the average age [M(SD)] was 52.3 (8.2) years; the average duration of H was 10 (8-12 years). The comparison and control groups were adequate for the purpose. The standard methods of parametric and non-parametric statistics processed the obtained data. 

Results: As a result of the study, significant differences were found in patients with hypertension and CD of both sexes compared with healthy individuals and patients with hypertension without cognitive impairment in relation to the daily blood pressure profile (VAR SBP, VAR DBP) both during the day and at night. The females, even middle-aged, with controlled hypertension but high systolic blood pressure variability, have a substantial risk of developing CD. Male patients with hypertension, even in the absence of CD, are more prone to depression, according to the HADS scale. In the presence of hypertension with CD, they are characterized by significantly worse personal-role physical and emotional functioning compared to female patients on the life quality scale. The often irresponsible attitude of men to the doctor's advice and regular antihypertensive treatment probably plays a significant role in the formation of gender differences in the quality of life of patients with hypertension and CD.

Conclusion: It is necessary to ensure early diagnosis and monitoring of CD as a marker of brain damage due to hypertension and determine the level of anxiety and depression, which significantly affect the psychological characteristics and quality of life even of patients with controlled hypertension, regardless of gender. However, middle-aged women, even with controlled hypertension but high SBP variability, have a priority risk of CD development.    


Holmen J, Holmen TL, Tverdal A, Holmen OL, Sund ER, Midthjell K. Blood pressure changes during 22-year of follow-up in large general population - the HUNT Study, Norway. BMC Cardiovasc. Disord. 2016, 16:94. doi: 10.1186/s12872-016-0257-8

Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. Intensive blood pressure lowering prevents mild cognitive impairment and possible dementia and slows the development of white matter lesions in the brain: the SPRINT Memory and Cognition IN Decreased Hypertension (SPRINT MIND) study. Blood Press. 2018;27:247

Lisko I, Kulmala J, Annetorp M, Ngandu T, Mangialasche F, Kivipelto M. How can dementia and disability be prevented in older adults: where are we today and where are we going? J Intern Med. 2021;289:807–30. https://doi. org/10.1111/joim.13227

Gabin, JM, Tambs K, Saltvedt, I., Sund, E., and Holmen, J. Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis: the

HUNT Study. Alzheimers Res. Ther. 2017, 9:37. doi: 10.1186/s13195- 017-0262-x

Hestad K, Engedal K, Schirmer H and Strand BH. The Effect of Blood Pressure on Cognitive Performance. An 8-Year Follow-Up of the Tromsø Study, Comprising People Aged 45–74 Years. Front. Psychol. 2020, 11:607. doi 10.3389/fps.2020.00607

Satizabal CL, Seshadri S. Role of improved vascular health in the declining incidence of dementia. Stroke. 2017;48:2013–20. https://doi. org/10.1161/STROKEAHA.117.013369.

Selmer R, Igland J, Ariansen I, Tverdal A, Njolstad I, Furu K, et al. NORRISK 2: a Norwegian risk model for acute cerebral stroke and myocardial; 2017.

Sindi S, Kåreholt I, Ngandu T, Rosenberg A, Kulmala J, Johansson L, et al. Sex differences in dementia and response to a lifestyle intervention: Evidence from Nordic population-based studies and a prevention trial. Alzheimers Dement. 2021;17:1166–78. doi:10.1002/alz.12279

Gorelick PB, Furie KL, Iadecola C, Smith EE, Waddy SP, Lloyd-Jones DM, Bae HJ, Bauman MA, Dichgans M, Duncan PW, Girgus M, Howard VJ, Lazar RM, Seshadri S, Testai FD, van Gaal S, Yaffe K, Wasiak H, Zerna C. Defining optimal brain health in adults: a presidential advisory from the American Heart Association/ American Stroke Association. Stroke. 2017;48:e284–e303

Sachdev PS, Lipnicki DM, Crawford J, Reppermund S, Kochan NA, Trollor JN, et al. Risk profiles for mild cognitive impairment vary by age and sex: the Sydney Memory and Ageing study. The American Journal of geriatric psychiatry. 2012;20:854–65.

Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, Cheung, AK, et al. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019, 321, 553–561. doi: 10.1001/jama.2018.21442

Hay M, Barnes C, Huentelman M, Brinton B, Lee R. Hypertension and Age-Related Cognitive Impairment: Common Risk Factors and a Role for Precision Aging. Current Hypertension Reports. 2020, 22: 80

Rouch L, Cestac P, Hanon O, Cool C, Helmer C, Bouhanick B, Chamontin B, Dartigues JF, Vellas B, Andrieu S. Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs. 2015, 29:113–130

Hopstock LA, Bonaa KH, Eggen AE, Grimsgaard S, Jacobsen BK, Lochen ML, et al. Longitudinal and secular trends in blood pressure among women and men in birth cohorts born between 1905 and 1977: the Tromso study 1979 to 2008. Hypertension. 2015, 66, 496–501. doi: 10.1161/hypertension aha. 115.05925

Gilsanz P, Mayeda ER, Glymour MM, Quesenberry CP, Mungas DM, DeCarli C, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017, 89:1886–93. doi:10.1212/WNL.0000000000004602.

Leening MJG, Ferket BS, Steyerberg EW, Kavousi M, Deckers JW, Nieboer D, Heeringa J, Portegies MLP, Hofman A, Ikram MA, Hunink MGM, Franco OH, Stricker BH, Witteman JCM, Roos-Hesselink JW. Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ, 2014, 349, g5992.

American Psychological Association Publication manual of the American Psychological Association : the official guide to APA style.

Scott J, Marshall G A Dictionary of Sociology, OUP Oxford; 2009.

Clayton JA, Tannenbaum C. Reporting sex, gender, or both in clinical research? JAMA – J Am Med Assoc. 2016, 316, 1863–1864

Abell JG, Kivimaki M, Dugravot A, Tabak AG, Fayosse A, Shipley M, et al. Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension. Eur. Heart J. 2018, 39, 3119–3125. doi: 10.1093/eurheartj/ehy288

Blanken AE, Nation DA. Does gender influence the relationship between high blood pressure and dementia? Highlight in areas for further investigation. J Alzheimers Dis. 2020, 78(1): 23–48. doi:10.3233/JAD-200245

Anstey KJ, Peters R, Mortby ME, Kiely KM, Eramudugolla R, Cherbuin N, et al. Association of sex differences in dementia risk factors with sex differences in memory decline in a population-based cohort spanning 20-76 years. Sci Rep. 2021, 11:7710. doi:10.1038/s41598-021-86397-7

Blanken AE, Nation DA. Does Gender Influence the Relationship Between High Blood Pressure and Dementia? Highlighting Areas for Further Investigation. J Alzheimers Dis. 2020, 78:23–48. doi:10.3233/JAD-200245

Song JJ, Ma Z, Wang J, Chen LX, Zhong JC. Gender differences in hypertension. J. Cardiovasc. Transl. Res. 2019, 27, 176–181. doi: 10.1007/s12265- 019-09888-z

Zutphen EM, Rijnhart JJM, Rhebergen D, Muller M, Huisman M, Beekman A, et al. Do Cardiovascular Risk Factors and Cardiovascular Disease Explain Sex Differences in Cognitive Functioning in Old Age? J Alzheimers Dis. 2021, 80:1643–55. doi:10.3233/JAD-201173

Kim S, Kim MJ, Kim S, Kang HS, Lim SW, Myung W, et al. Gender differences in risk factors for transition from mild cognitive impairment to Alzheimer’s disease: A CREDOS study. Comprehensive Psychiatry. 2015, 62:114–22. https://

Nespollo AM, Marcon SR, Lima NVP, Dias TL, Espinosa, MM. Health Condition sand Memory Performance: a study with older adult women. Rev. BrasEnferm. 2017, 70, 640–646. doi: 10.1590/0034-7167-2016- 0529

Pankratz VS, Roberts RO, Mielke MM, Knopman DS, Jack CR, Geda YE, et al. Predicting the risk of mild cognitive impairment in the Mayo Clinic Study of Aging. Neurology. 2015, 84:1433–42. WNL.0000000000001437

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975, 12, 189–198

Koepsell TD, Monsell SE. Reversion from mild cognitive impairment to normal or near Normal cognition; Risk factors and prognosis. Neurology. 2012, 79, 1591–1598.

Visser PJ, Kester A, Jolles J, Verhey F. Ten-year risk of dementia in subjects with mild cognitive impairment. Neurology. 2006, 67, 1201–1207.

How to Cite
Krotova, V., Rosytska, O., & Khomazyuk , T. (2023). Cognitive Disorders in Patients with Hypertension: Are There Gender Differences?. Journal of Internal Medicine: Science & Art, 4, 33 - 42.