Arterial Stiffness and Other Vasculatures Impairments That Cause in Hypertensive Older Patients and Smoking Cognitive Impairments Are Not Linked to Gender
To the Editor:
The article by Kearney-Schwartz et al1 explains the mechanism by which cognitive impairments in the elderly can happen in hypertensive patients.
They suggest that memory impairment was only observed in men and explain this fact by possible differential effects of gender in hypertensive patients at an early stage of cognitive impairment.
They omitted to tell us in their paragraph discussion, that only 15% of women were smokers or exsmokers versus 66% of men.
Hill2 has done a study in which he concluded that the residual effects of current cigarette smoking negatively influenced speeded cognitive capabilities in older adults, and exsmokers did not differ from smokers in their performance on any of the cognitive tasks. Moreover, Reitz et al3 found that current smokers aged >75 years had cognitive and memory impairment than their peers who do not smoke. Finally, the Rotterdam Study4 demonstrates that current smoking increases the risk of dementia and Alzheimer disease.
On the other hand, Mahmud et al5 in their study found that hemodynamic consequences of chronic smoking increase arterial stiffness and arterial wave reflection, which leads to increased aortic systolic blood pressure, and chronic smoking females are not protective from such vascular effects.
This finding about smoking and genesis of arterial stiffness is comforted by Jatoi et al,6 Polonia et al,7 and Liang et al8 in their respective studies. They all demonstrate, after a long period of smoking cessation, a clear improvement of pulse wave velocity, central pressure, and vascular stiffness.
Smoking has a central role in the genesis of vascular disturbances in this particular study, and gender is not the cause of the difference noted in the study.
Kearney-Schwartz A, Rossignol P, Bracard S, Felblinger J, Fay R, Boivin J-M, Lecompte T, Lacolley P, Benetos A, Zannad F. Vascular structure and function is correlated to cognitive performance and white matter hyperintensities in older hypertensive patients with subjective memory complaints. Stroke. 2009; 40: 1229–1236.
Reitz C, Luchsinger J, Tang M-X, Mayeux R. Effect of smoking and time on cognitive function in the elderly without dementia. Neurology. 2005; 65: 870–875.
Reitz C, den Heijer T, van Duijn C, Hofman A, Breteler MMB. Relation between smoking and risk of dementia and Alzheimer disease: the Rotterdam Study. Neurology. 2007: 69: 998–1005.
Mahmud A, Feely J. Effect of smoking on arterial stiffness and pulse pressure amplification. Hypertension. 2003; 41: 183–918.
Jatoi NA, Jerrard-Dunne P, Feely J, Mahmud A. Impact of smoking and smoking cessation on arterial stiffness and aortic wave reflection in hypertension. Hypertension. 2007; 49: 981–985.
Liang Y-L, Shiel LM, Teede H, Kotsopoulos D, McNeil J, Cameron JD, McGrath BP. Effects of blood pressure, smoking, and their interaction on carotid artery structure and function. Hypertension. 2001; 37: 6–11.