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Arterial stiffness measured by pulse wave velocity correlated with cognitive decline in hypertensive individuals: a systematic review

BMC Neurology volume 24, Article number: 393 (2024) Cite this article

Abstract

Background

Arterial stiffness is a degenerative modification in the arterial wall that significantly affects normal aging. Arterial hypertension is a major risk factor for cerebrovascular impairment. Pulse wave velocity (PWV) is an established gold standard for measuring arterial stiffness. Studies demonstrated that individuals with elevated blood pressure (BP) and PWV are more likely to experience worse cognitive decline compared to those with either condition alone. The aim of this review is to explore the clinical importance of arterial stiffness for cognitive function in older adults with hypertension.

Methods

The systematic review was reported following the PRISMA 2020 guidelines and Cochrane protocol and was registered in NIHR PROSPERO. PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched for relevant publications up to December 2022. Articles were filtered by age and type of study and only those including a sample size of at least 500 individuals were selected. Screening of abstracts and full-text review of selected articles were carried out through Covidence.

Results

The full-text review included a total of 434 articles. Twenty-eight prospective studies have met the inclusion criteria. Selected studies used PWV as the main measurement of stiffness: 24 used carotid-femoral, 2 used brachial-ankle, 1 used aortic PWV, and 11 compared different measures. Studies demonstrated a strong association between increased BP and PWV with brain damage and cognitive deterioration among older adults. One study did not find an interaction with hypertension, while another study found that PWV but not BP was associated with cognitive decline. Few studies showed that the association between stiffness and cognitive outcomes was not significant after adjustment for BP. Several authors suggested that cognitive decline induced by stiff vasculature and hypertension benefited from antihypertensive therapy.

Conclusion

The results of this review demonstrated that arterial hypertension is an important factor linking arterial stiffness to cognitive health in older individuals. BP plays a crucial role in brain integrity, whereas PWV was shown to be a strong measure associated with cognitive decline. Together, they can lead to disabling cognitive outcomes. Early screening of stiffness, BP control, and compliance with treatment are essential for cerebrovascular disease prevention.

Trial registration

NIHR PROSPERO registry ID: CRD42022379887.

Peer Review reports

Introduction

The lifespan of humans has increased considerably during the last centuries. In the US, the number of adults older than 65 years was 54.1 million (16%) in 2019. By 2060 this number will increase to 25% (cdc.gov, 2022). Hypertension is a well-known risk factor for cerebral and cardiovascular diseases [1,2,3,4,5] and has continued to be a major public health problem for the last decades. Nearly half (47%, or 116 million) of the adults in the United States (US) have elevated BP. Aging is a heterogenic and dynamic process that progressively limits normal functioning and makes people susceptible to disease and death [6]. With advancing age and chronically increased BP, the elasticity of the arterial wall decreases, subsequently causing an increase in PWV. Elevated PWV is associated with the propagation of pulsatile flow to the brain, endothelial injury [7], decreased blood flow [7, 8], and a decreased ability of the brain to adapt to changes in blood flow [8]. This can lead to a decline in cognitive performance [9] and an increased risk of vascular dementia, although it varies between individuals. The incidence of cerebrovascular diseases (CeVD), particularly cerebral small vessel disease (CSVD), increases with extended life expectancy [10, 11], causing disability, mild cognitive impairment (MCI), and dementia [12, 13]. In the US, vascular cognitive impairment and hypertension are the top 5 causes of disability in the population older than 65 years (cdc.gov, 2022). 2013 European Society of Hypertension/European Society of Cardiology (ESH/ESC) [5] and 2015 American Heart Association (AHA) [14] recommended carotid-femoral PWV (cfPWV) as a gold standard for arterial stiffness research and an independent predictor for fatal and non-fatal cardiovascular events in hypertensive patients [15]. The process of vascular aging is exaggerated by concurred hypertension which has the strongest association with vascular events [16]. High BP, dyslipidemia, diabetes mellitus (DM), obesity, and other traditional cardiovascular risk factors are often not diagnosed timely and thus, remain undertreated or if treated, are poorly controlled [17].

Objectives of this review: (1) systematically review recent literature on arterial stiffness, hypertension, and cognitive function in aging and establish gaps where future research could be of benefit, (2) propose mechanistic links between arterial stiffness, hypertension, and cognitive function in aging, (3) assess the clinical ability of pulse wave velocity, as the measure of arterial stiffness, to predict cognitive decline in aging, (4) assess the potential of arterial stiffness to serve as a biomarker of cognitive decline.

Methods

Literature search

Search strategy

We searched PubMed, Embase, Cochrane CENTRAL, CINAHL, Web of Science, and Scopus platforms without data or language limits. We included abstracts from the database. The search strategy included a combination of subject headings and text words for the concepts of arterial stiffness, pulse wave velocity, cognitive decline, arterial hypertension, and their synonyms. The supplementary material presents an example of a search strategy in the PubMed database (Supplementary material, Search strategy). The age older than 45 years was used as a filter. There was no limit to the publication date.

Eligibility criteria

We screened all eligible studies, including clinical randomized trials, case-control, cohort, cross-sectional, longitudinal, experimental pilot, and community-based, as well as database analyses.

Inclusion criteria

We included studies published worldwide, studies using PWV and cognitive disorders measurements (neuropsychological tests and neuroimaging), studies on stroke-free and psychiatric disorders-free populations, articles reporting an odds ratio or hazard ratio for the relationship between exposure and outcome, and studies that included at least 500 participants older than 45 years.

Exclusion criteria

The exclusion criteria included studies that used a case report or case-series study design, articles without PWV measurement of arterial stiffness, articles that did not report a statistic for the association between arterial stiffness and cognitive changes, a sample size of less than 500 participants, and participants younger than 45 years.

Study selection

First, we completed the title and abstract screening to create a primary list. Then, the full texts were screened for additional information to decide if the studies were eligible. The duplicates and irrelevant articles were removed. The first reviewer (BA) assessed the eligibility criteria, and the second reviewer (TA) screened the articles and worked on the PRISMA flowchart and tables. A third reviewer (TR) was brought in to resolve any discrepancies in the selection. All relevant articles were collected in EndNote and screening was completed through the Covidence voting system.

Data extraction and analysis

We extracted data from the selected articles using pre-piloted data extraction forms prepared in Excel. The extracted data included: (1) subject characteristics (sample size, mean age, gender distribution, race and ethnicity distribution, BP), (2) exposure (stiffness measurements [cfPWV, brachial-ankle PWV (baPWV), aortic PWV (aoPWV), carotid-radial PWV (crPWV), or estimated PWV (ePWV)]), (3) outcome information based on neuropsychological tests of cognitive function [Mini-Mental State Examination (MMSE), modified MMSE (3MSE), and Montreal Cognitive Assessment (MoCA)] and imaging-based studies of the brain [computer tomography (CT) and magnetic resonance imaging (MRI)]. We considered appropriate inclusion/exclusion criteria when selecting the published articles.

Arterial hypertension, stiffness, and cognitive function were evaluated using the following measurements, techniques, guidelines, and devices:

  1. (1)

    Blood pressure: systolic (SBP) and diastolic (DBP), were measured by a sphygmomanometer, electronically calibrated manometer “Omron,” “Dinamap,” “Meditech,” 24 h ambulatory BP monitors. Mean arterial pressure (MAP) and pulse pressure (PP) were the calculated BP measurements. The units of BP measurement were mmHg. The percentage of hypertensive individuals and/or individuals on antihypertensive therapy throughout the studies is reflected in the summary table (Table 1).

  2. (2)

    Arterial stiffness was assessed by different techniques and devices: Complior, Sphygmocor, AtCor, DiaTecne srl, SMT Medical, pOpmetre, Vicorder, PulseTracePCA2 for PWV, VaSera for cardio-ankle vascular index (CAVI), and Doppler Sonography. The measurements of arterial stiffness included PWV, PP, PP amplification, ankle-brachial index, CAVI, augmentation index (AI), carotid AI, characteristic impedance, carotid augmented pressure, forward/backward pressure amplitude, excess pressure integral (XSPI), Young’s elastic modulus, and pulsatility index. We chose to use the following measurements of arterial stiffness: cfPWV, aoPWV, baPWV, crPWV, and ePWV. The means are listed in Table 2.

  3. (3)

    The cognitive function was evaluated via a battery of multiple neurocognitive tests that are listed in the summary table (Table 1). The results of the studies are summarized in Table 2. The most widely used clinical screening tests for cognitive function assessment were MMSE, MoCA, and 3MSE. The assessment of brain damage was provided by neuroimaging studies, such as CT and MRI. The MRI classification of CSVD was: (1) recent small subcortical infarct classified as acute lacunar infarct, (2) white matter hyperintensity (WMH), (3) silent lacunar infarct, (4) cerebral microbleed, and (5) perivascular spaces (PVS) [18].

Definitions

Arterial stiffness is an aging process in the arterial wall characterized by degeneration of elastic fibers, an increase in collagenous material, and calcium deposition [19].

2017 ACC/AHA defined stage 1 hypertension as BP at or above 130/80 mmHg, and stage 2 hypertension at or above 140/90 mmHg [20].

MCI is an early stage of memory loss or other cognitive ability loss with the preserved ability to independently perform most activities of daily living; 5–53% of MCI cases progress into dementia, and 15% into Alzheimer’s disease (AD) [11].

Dementia is an impaired ability to remember, think, or make decisions that interfere with daily activities. It is caused by the degeneration and loss of neurons and neuronal connections in the brain. The affected area causes the symptoms of dementia. Dementia is not a part of normal aging. AD is the most common type of dementia [21].

Reporting bias assessment

We used the QualSyst tool to evaluate the studies [22]. Scores for the quality assessment of the studies were calculated based on a 14-item checklist provided in the tool (Supplementary material, Table s1). Scoring above 55% was recommended as the quality inclusion threshold the QualSyst.

Synthesis of results

Table 1 summarizes the chosen studies’ exposure and outcome data. Table 2 differentiates the PWV measurement by type and includes the results. The cognitive outcomes are compared with arterial stiffness to identify any correlations with increased blood pressure. The combined effect measures were not calculated due to the multiple types of neuropsychological tests used to score the outcome.

Table 1 Summary
Full size table
Table 2 The association of pulse wave velocities with cognitive function, cognitive decline, and brain damage markers. (Results section)
Full size table

Results

Study selection

The PRISMA flow diagram (Fig. 1) was created using the PRISMA 2020 flow diagram template for systematic review [23].

Fig. 1
figure 1

Flow diagram of the study selection

Full size image

Study characteristics and results of individual studies

Each of the included study characteristics, such as study design, follow-up, age, sex, and other variables, as well as outcome, are described in Table 1. Chosen studies were classified by:

  1. (1)

    Sample size: n > 1000 (17 studies), n = 500–1000 (11 studies) participants. The total sample size in this review is n = 56,858.

  2. (2)

    Years of publication: 24 papers were published from 2012 to 2022 and 4 papers were published before 2012. The first relevant paper matching the eligibility criteria was published in 2007.

  3. (3)

    Age: the youngest participant was 45 years old, the oldest was 92 years old, and the average age of participants was 66.9 years old.

  4. (4)

    Gender: 55.6% of participants were women.

  5. (5)

    The most known and oldest ongoing study was the Framingham Heart Study (FHS), which began 75 years ago. This review includes four studies of third-generation FHS offspring.

  6. (6)

    All the studies were prospective: 13 of them used cross-sectional analysis and 15 studies were assessed longitudinally. The follow-up period ranged from 1 to 25 years.

Risk of bias in studies

Our team used the QualSyst tool to evaluate the quality of quantitative studies [22] (Supplementary material, Table s1). All selected articles met the recommended threshold.

Data synthesis

The review of reports demonstrated an association between hypertension-related arterial stiffness and cognitive dysfunction. Chronically elevated BP causes the arterial wall to be more fibrotic, hypertrophic, and stiff. Subsequently, these structural changes exacerbate vascular remodeling and promote vascular aging [24,25,26,27,28]. Vascular stiffness and elevated BP cause microvascular brain damage [29,30,31] and contribute to stroke [32, 33], cognitive deterioration [34,35,36], and vascular dementia [37, 38]. The correlation between arterial stiffness and cognitive decline was reported in multiple studies. Hajjar et al. reported that hypertensive individuals with stiffness had a worse decline in executive function (p = 0.004), working memory (p = 0.039), and memory scores (p = 0.018). Stiffness was a better predictor of cognitive impairment than BP. Also, stiffness explained the association between hypertension and executive function [39]. After adjustment for MAP and hypertensive therapy, a significant association between higher cfPWV with MCI (HR = 1.41, p = 0.01), but not dementia or AD was shown by Pase et al. in the FHS [40]. Nilsson et al. analyzed the association of stiffness with dementia in the Malmo Diet and Cancer Study (MDCS). The results were similar: (1) cross-sectional analysis demonstrated the highly significant association between cfPWV > 13.8 m/s with MMSE (b=-0.37, p = 0.016) and a quick test of cognitive speed (AQT, b = 4.81, p = 0.004) scores [35]; (2) longitudinally, after adjustment the association between cfPWV with prevalent dementia (OR = 0.95, p = 0.40) and incident dementia (OR = 1.0, p = 0.96) was not significant [41]. Watson et al. demonstrated the association between central stiffness and psychomotor speed decline (OR = 1.42) independent of hypertension [42]. Menezes et al. indicated a faster decline in cognitive performance among older adults (verbal fluency test, b=-0.02, p < 0.01) [43]. Araghi et al. showed that higher tertile of cfPWV (> 8.91 m/s) had the highest rate of hypertension (41.6%) and faster cognitive decline (b=-0.06, p = 0.01) [44].

White matter hyperintensities, enlarged PVS, and total cerebral brain volume were brain damage markers in MRI-based studies and considered causes of cognitive decline. The Age, Gene/Environmental Susceptibility Study (AGES-Reykjavik) demonstrated a bidirectional relationship between BP and stiffness associated with brain damage and cognitive impairment. The results showed a significant relationship between elevated cfPWV and microbleeds (OR = 1.12), cerebellar infarct (OR = 1.30), subcortical infarct (OR = 1.30), and memory change (b=-0.071 ± 0.023, p = 0.002, r2 = 0.19) [45]. Earlier, in the same study, Mitchel et al. found a significant association between elevated cfPWV with subcortical infarction (HR = 1.62–1.71, p < 0.001), WMHV (b = 0.108 ± 0.045, p = 0.018), and lower memory score (b=-0.095 ± 0.043, p = 0.028) [46]. The Silent Stroke Study in hypertensive individuals reported the association between increased cfPWV and CSVD load (OR = 1.42, p < 0.001), lacunes (OR = 1.51, p = 0.005), and PVS (OR = 1.39, p = 0.001) [47]. Maillard et al. demonstrated in the third-generation offspring of FHS that cfPWV has a direct mediating effect (a = 0.040, p < 0.001) on the association between SBP and free water (a biomarker of cerebral injury contributing to white matter degeneration) [48].

Routine assessment of older hypertensive individuals for cognitive decline was highly recommended to prevent and postpone cognitive burden by 2020 ESH/EGMS (European Geriatric Medicine Society) [49]. At very advanced age, people are prone to episodes of systolic hypotension [50], which, in conjunction with stiff vasculature, may cause severe cognitive impairment [51]. The Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized and Very Aged Population (PARTAGE) study [52] showed that PWV, but not BP, was associated with cognitive decline in institutionalized individuals older than 80 years (r=-0.005, p = 0.88). This is probably due to comorbidities, lower BP, and very low vascular compliance. The worse MMSE at the baseline and in 1 year (-2.20 ± 3.98, p < 0.03 and 21.3 ± 6.0, p < 0.05 respectively) was associated with higher tertile of cfPWV (20.1 ± 4.0) [52]. Antihypertensive therapy consistently showed a significant improvement in BP and PWV levels in individuals with stiff vasculature [53, 54] and cognitive impairment [39, 55].

Endocrinal causes may mediate the association between aging vasculature and cognitive performance. Collin et al. reported the differences between males and females in the MRI-based study: the larger white matter hyperintensity volume (WMLV) was significantly associated with higher central SBP among females (OR = 1.27, p < 0.05), whereas in males, the higher periventricular WMLV was significantly associated with higher aortic stiffness (OR = 1.48, p < 0.05) [31].

Oxidative stress, vascular inflammation, autoimmunity activation, and atherosclerotic modulation promote arterial aging, cardiovascular events, and stroke [56]. A strong correlation between metabolic factors, neuroinflammatory markers, cerebral microvascular changes, and white matter lesions with cognitive decline was shown through several studies [57]. Global MARE Consortium (Metabolic Syndrome and Artery Research) considered metabolic syndrome as a mechanism explaining vascular aging, which in some individuals predisposes to earlier and in others to healthier vascular aging. The lower pulse wave velocities correspond to healthier vascular aging [58]. Supernormal vascular aging is a protective phenotype of low PWV values. It can be diagnosed in individuals with extremely low arterial stiffness for their age and sex [59]. Some populations, such as Yanomamo Indians, Papua New Guinea, and rural Kenyans, do not have an increased incidence of hypertension with advancing age [60]; they have a good aerobic load, low cholesterol, low sodium, and high fiber carbs diet [61]. Oppositely, early vascular aging syndrome, first described in 2008, explains the effect of premature vascular aging with abnormal arterial function [62, 63].

Increased vascular stiffness elevates cardiovascular risk [64,65,66,67,68] and demonstrates an association of cognitive decline with cardiovascular risk factors [69,70,71,72] and multiple end-organ damage [73,74,75,76]. Recently, Scuteri A. et al. defined SHATS (systemic hemodynamic atherosclerotic syndrome) as a combination of left ventricular hypertrophy, common carotid artery damage, and chronic kidney disease (CKD) [75,76,77,78]. Left ventricle remodeling and fibrosis can cause cerebrovascular hemodynamic changes with cognitive impairment [79] independently of blood pressure [80]. In recently diagnosed hypertensive individuals, stiffness was associated with microalbuminuria related to cerebral microcirculatory changes and, as a result, caused cognitive damage [81]. The Predictors of Arrhythmic and Cardiovascular Risk in End-stage Renal Disease (PACE) study found an association between cfPWV and lower cognitive test scores in end-stage renal disease patients. This association was attenuated after adjustment for DBP: 3MSE score at the baseline (OR = 4.68, p = 0.20) and in 1 year (OR = 0.12, p = 0.43) [78]. In individuals on hemodialysis, stiffness may deteriorate due to progressive calcification in the arterial wall [82]. Stiffness is a risk factor for cardiovascular disease, myocardial infarction, and stroke because of the strong association with atherosclerotic plaques and thickened intima-media [83]. A positive correlation between stiffness and aortic atherosclerosis was also confirmed in the autopsy study [84].

Studies used multiple biomarkers of arterial stiffness other than cfPWV, such as aoPWV, baPWV, crPWV, ePWV, PP, and pressure integrals. Amier et al. used cardiovascular MRI to measure aoPWV. The results showed that the severity and burden of hypertension were directly related to worse CSVD (OR = 1.17, p = 0.003) and cognitive impairment [85]. The baPWV was used to measure stiffness in Japanese [38] and Chinese [30] studies. Taniguchi et al. reported an independent association between the highest and middle tertiles of baPWV with cognitive decline (OR = 2.95 and OR = 2.39 respectively) [38]. Han et al. used MRI-DTI to assess the association of baPWV with white matter integrity: the association was significant (p < 0.05), and MMSE scores were worse in those with elevated PWV (b=-0.093, p = 0.011) [30]. Atherosclerosis Risk in Communities (ARIC) study compared central PP with cfPWV, and the results were similar: participants with elevated cfPWV had larger WMH (p < 0.007), smaller total brain volume, lower scores for executive function/processing speed (b=-0.04, p < 0.05) and global performance (b=-0.09, p < 0.05) [86]. Previously, in the same study, among White individuals, those with higher PP showed a higher prevalence of MCI (OR = 1.27) and dementia (OR = 1.76), as well as those with elevated cfPWV and SBP, had a higher prevalence of MCI (OR = 1.27). The estimates variance among Black participants with CSVD was large, and the association between cfPWV, cPP, and cSBP with MCI and dementia was not statistically significant. There was no effect modification by hypertension or diabetes after adjustment [36]. Similarly, in the Baltimore Aging Study, PP and cfPWV were significantly associated with lower cognitive scores (p < 0.05) before clinical symptoms of dementia [87].

Tsao et al. assessed the association between stiffness, measured with cfPWV, MAP, central PP, and neurocognitive outcomes cross-sectionally [88] and longitudinally [55]: increased cfPWV was associated with executive function decline (b=-0.10 ± 0.04, p < 0.05), elevated MAP was associated with larger WMHV (b=-0.07 ± 0.03, p = 0.017). The longitudinal results from the Rotterdam Study reported no association between stiffness and cognitive decline (OR = 0.93), dementia (OR = 0.91), or AD (OR = 0.90) after adjustment for cardiovascular risk factors [89]. Later, the cross-sectional analysis showed that in uncontrolled hypertensive individuals, cfPWV was associated with CSVD: WMLV (difference in volume = 0.09 per SD increase); lacunar infarcts (OR = 1.63), and deep microbleeds (OR = 2.13). However, in the group with controlled BP and without hypertension, there was no association between cfPWV and CSVD [90].

Carotid-radial was compared with carotid-femoral PWV among residents of Madison, Wisconsin, by Zhong et al. The results failed to find an association between crPWV and cognitive scores. However, cfPWV > 12 m/s was significantly associated with lower MMSE (p = 0.005), auditory verbal learning test (p = 0.01), and composite cognition scores (p = 0.04) [91]. The association of cognitive function with XSPI and cfPWV was compared in the Taipei Study. The results reported no significance with cfPWV but a significance with XSPI (OR = 1.30), likely, due to aortic pulsatility load [92]. Similarly, in the Maastrich Study, the aortic but not carotid stiffness was independently associated with worse cognitive scores (b=-0.018) and larger microvascular damage (b=-0.018, p < 0.05) due to increased pulsatility load [93].

The estimation of PWV (ePWV) was calculated using age and BP and showed an association with increased incidence of CeVD in the Kailuan Study (China, n = 98,348) [94], the Systolic Blood Pressure Interventional Trial (SPRINT) (Greece, n = 8,450) [95], Danish Monitoring Trends and Determinants in Cardiovascular Disease (MONICA, n = 2,366) [96], and General Chinese Population Study (n = 7,012) [97]. Heffernan et al. indicated an inverse association between elevated ePWV and lower cognitive digit symbol substitution test scores among Black (b=-3.47, p < 0.001) and White (b=-3.51, p < 0.001) adults [34].

It is important to mention that 24-hour blood pressure fluctuation associated with atherosclerotic arterial stiffness mostly impacts the carotid pool (113) and was suggested as a contributor to vascular dementia and AD [98]. In individuals with masked and white coat hypertension, BP alteration is associated with arterial structure and function, with greater concentric arterial remodeling among women [99].

Cerebral hypoperfusion was established as a cause of cognitive decline in multiple studies [100,101,102]. Whereas, in the aging population, pathological vascular mechanisms may be masked by parallel biological processes, routine PWV screening was recommended in the middle-aged population [35, 97, 103, 104]. Carotid-femoral PWV was shown as an independent predictor of mortality in individuals with essential hypertension [105], type 2 diabetes [106], and end-stage CKD [106, 107]. A 1 m/s elevation in PWV was significantly associated with 11% elevation of cardiovascular and 12% all-cause mortality [108]. However, PARTAGE [109], Pronostic Cardiovasculaire Optimization Therapeutique en Geriatric Study (PROTEGER) [110], and metanalysis of 17,635 individuals by Ben-Shlomo et al. [111]. showed that after adjustment for cardiovascular risk factors in older adults, PWV was not predictive of future fatal and nonfatal cardiovascular events.

Discussion

Age a priori is associated with a change in arterial geometry that leads to increased stiffness and blood pressure over time. The carotid-femoral PWV was found to be more predictive of cognitive decline, whereas hypertension plays a crucial role in cerebrovascular function and brain integrity.

Although some studies were included several times, they were conducted at different time points with different population sizes and addressed different research questions. We treated population studies and interventional studies in the same manner and acknowledged that this may be a potential limitation. However, the results seem to converge and lead to similar conclusions.

Arterial stiffness measured with PWV is significantly associated with cognitive decline in aging individuals with chronically elevated BP. The results show that arterial hypertension is one of the most important risk factors in this association. Multiple other factors contribute to the link between hypertension, stiffness, and cognitive dysfunction as well. These factors include hemodynamic, immunologic, metabolic, neuro, and vascular inflammatory processes, as well as cardiac and renal comorbidities. The mechanism behind cerebral damage and cognitive dysfunction is complex and manifests at micro- and macrovascular levels, such as white matter lesions, microinfarcts, microbleeds, enlarged PVS, and cortical atrophy and neurodegeneration.

Aging individuals are among the most vulnerable populations. They are at the highest risk for developing disabling cognitive impairment and sooner death due to multiple vascular risk factors and chronic comorbidities. Our review showed that accelerated arterial stiffness and higher blood pressure significantly lower cognitive abilities and mental functionality and predispose to worse cardiovascular outcomes and CSVD. Reducing the burden of cardio- and cerebrovascular events by lowering risk factors is complex and suboptimal [17]. Therefore, early screening of high-risk individuals, intensive treatment, and effective prevention of vascular risk factors and cognitive decline in the aging population should be implemented to provide a better quality of life, promote personal independence, and reduce social burden and healthcare costs [112, 113].

The goal of this review was achieved. We captured current relevant studies (Objective 1). There is a negative relationship between arterial stiffness and microvascular cerebral impairment with cognitive dysfunction. Further analysis of published longitudinal studies confirmed this negative association. The selected studies demonstrated a strong association between arterial stiffness, measured with pulse wave velocity, and cognitive decline. After controlling for covariates, such as age, sex, and blood pressure, the negative association between arterial stiffness and cognitive function was maintained in 25 studies. The consistency of this association was strengthened by the findings from studies, regardless of the duration of the follow-up periods.

The MDCS [41], Rotterdam [89], and ARIC-NC [36] studies reported no association between cfPWV with MCI, dementia, and AD after adjustment for cardiovascular risk factors. Later, Palta et al. analyzed data from the ARIC-NC study longitudinally and found that higher cfPWV was associated with AD; however, a significant interaction by hypertension was not observed [86]. Factors such as CKD, metabolic syndrome, and genetic predisposition influenced the relationship between cognitive function and arterial stiffness [78].

The Rotterdam Study (2007) with n = 2,767 (4.9% of the total sample size of all analyzed studies) reported no association between stiffness and cognitive decline after adjustment [89]. Later, the cross-sectional analysis indicated a correlation between higher levels of cfPWV and larger volumes of WMH after adjusting for MAP, heart rate, and cardiovascular risk factors [90].

Objective 2 was supported by the following results: (1) a stiff aorta promotes increased blood flow to the fragile cerebral small vessels contributing to microcirculatory impairment, (2) cerebral hypoperfusion may induce brain damage, such as WMH, lacunar infarcts, etc., and (3) endothelial dysfunction contributes to hypertension and, as a result, to stroke [44].

Clinical use of biomarkers depends on predictive value, technical availability, and cost of the procedure. Importantly, in analyzed studies, the gold standard for arterial stiffness cfPWV, as well as aoPWV, baPWV, and crPWV were measured noninvasively via specialized devices; ePWV was quantified from age and mean arterial pressure. In the prediction of cardiovascular events ePWV cannot substitute but rather be additive to cfPWV: the estimated measure is not predictive in individuals with high risk. Also, the formula of ePWV includes MAP and, therefore, could be influenced by treated hypertension [114]. The MONICA study reported that a 1 m/s increase in ePWV was associated with a 20% increase in mortality risk [115].

Results of the review support Objective 3: earlier screening of cfPWV improves prognoses of cerebrovascular events, cognitive decline, disability, morbidity, and mortality. Adequate treatment, adherence, and compliance can change the prognosis of the patient and reverse the stiffening process. Many decades of attempting to produce drugs that reduce dementia-related neurodegenerative pathways have failed to show significant clinical benefits [116]. Hajjar et al. [39] and Tsao et al. [55] showed that therapeutic management of hypertension-related arterial stiffness was beneficial for cognitive health. A healthy diet and lifestyle modification minimize cognitive decline in the aging population. Factors like high levels of education, body mass index, physical activity, intensive treatment of hypertension, as well as education programs are protective among non-compliant patients. Regular aerobic exercise and reduced sodium intake were clinically effective in the prevention and treatment of arterial stiffness [117].

To support Objective 4, it was found that a group of experts proposed to implement a classification and staging of aging-related diseases, as well as a scoring system of tissue and organ senescence to evaluate patients’ status and guide policy at the World Health Organization and government level [118]. The control of hypertension demands planned collective action and the adoption of actions at the National level [119]. The paradigm of effective prevention should be shifted from traditional risk factors to arterial aging [17]. The proclamation that calls for joint prevention of stroke and dementia, data harmonization, and translation into action was issued by the World Stroke Organization and endorsed by 23 international, regional, and national organizations [120, 121]. The guidelines for standardized clinical evaluation of cognitive function in hypertensive patients were elaborated by a group of experts from ESH and EGMS in 2020 [49].

The results from this review show that arterial stiffness, measured by PWV is a strong predictor of cognitive decline in hypertensive individuals older than 45 years, independent of any specific demographics. Pulse wave velocity is a non-invasive, reliable method to determine arterial stiffness and is a marker of brain health. The earlier onset of cognitive decline is associated with higher progression rates of worse cerebrovascular outcomes. Thus, a PWV assessment could be included as a routine examination for high-risk adults for the prevention of cardiovascular and cognitive events.

The strength of this review is its inclusion of comprehensive prospective studies with substantial sample sizes that were methodologically analyzed prospectively and cross-sectionally. In geographically, racially, and ethnically diverse elderly populations with comorbidities, the influence of arterial stiffness on cognitive health was confirmed. Out of the 28 studies, the majority (23) utilized gold standard carotid-femoral pulse wave velocity (cfPWV) for assessing arterial stiffness. Additionally, studies compared various measures of arterial stiffness, and the longitudinal analyses covered a period of up to 25 years. Furthermore, several studies suggested the beneficial effects of antihypertensive therapy on arterial stiffness and, consequently, on cognitive outcomes.

The limitations of this systematic review are: (1) the methods and tools used to measure cognitive function varied across the included studies, (2) heterogeneity in outcome measurements was found among the included studies, (3) cause-effect could not be inferred from the cross‐sectional analyses, (4) population sizes from different continents varied across studies, 5) multiple studies were included several times, however, they were conducted at different time points with different population sizes and addressed some different research questions.

Conclusion

Based on this systematic review, it was established that there is a negative association between arterial stiffness and cognitive function among older adults with hypertension. The future direction suggests that early screening of PWV could play a crucial role as a significant clinical biomarker for middle-aged individuals with hypertension and older asymptomatic individuals at high vascular risk for cognitive decline and stroke. It is imperative to implement interventions aimed at reducing and preventing cerebrovascular events in the aging population. This proactive strategy could significantly contribute to improving the overall brain health of at-risk individuals.

Registration and protocol

The protocol for the systematic review was registered on the NIHR PROSPERO.

Registry ID: CRD42022379887.

A systematic literature review protocol was provided based on the Cochrane Handbook for Systematic Reviews of Interventions, 2022 [122].

The systematic review was based on the PRISMA 2020 statement: An updated guideline for reporting systematic reviews [23].

Data availability

All data generated during this review are included in this published manuscript. The NIHR PROSPERO protocol is available at https://www.crd.york.ac.uk/PROSPERO/.

Abbreviations

CINAHL:

Cumulated index to nursing and allied health literature

NIHR PROSPERO:

National Institute for Health Research International Prospective Register of Systematic Review

PRISMA:

Preferred Reported Items for Systematic Reviews and Meta–Analyses

References

  1. Comfort A. Feasibility in age research. Nature. 1968;217(5126):320–2.

    Article  CAS  PubMed  Google Scholar 

  2. Jefferson AL, Hohman TJ, Liu D, Haj-Hassan S, Gifford KA, Benson EM, Skinner JS, Lu Z, Sparling J, Sumner EC, Bell S, Ruberg FL. Adverse vascular risk is related to cognitive decline in older adults. J Alzheimers Dis. 2015;44(4):1361–73.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Boytsov SA, Samorodskaya IV. [Cardiovascular disease and cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova. 2022;122(7):7–13.

    Article  CAS  PubMed  Google Scholar 

  4. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM, Nelson SA, Nichol G, Orenstein D, Wilson PWF, Woo YJ. Forecasting the future of Cardiovascular Disease in the United States. Circulation. 2011;123(8):933–44.

    Article  PubMed  Google Scholar 

  5. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357.

    Article  CAS  PubMed  Google Scholar 

  6. Sachdev PS, Lipnicki DM, Crawford J, Reppermund S, Kochan NA, Trollor JN, Wen W, Draper B, Slavin MJ, Kang K, Lux O, Mather KA, Brodaty H. Factors predicting reversion from mild cognitive impairment to normal cognitive functioning: a population-based study. PLoS ONE. 2013;8(3): e59649.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Avolio A, Kim MO, Adji A, Gangoda S, Avadhanam B, Tan I, Butlin M. Cerebral haemodynamics: effects of systemic arterial pulsatile function and hypertension. Curr Hypertens Rep. 2018;20(3):20.

    Article  PubMed  Google Scholar 

  8. Claassen J, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev. 2021;101(4):1487–559.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Koepsell TD, Monsell SE. Reversion from mild cognitive impairment to normal or near-normal cognition: risk factors and prognosis. Neurology. 2012;79(15):1591–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nordlund A, Rolstad S, Klang O, Edman A, Hansen S, Wallin A. Two-year outcome of MCI subtypes and aetiologies in the Göteborg MCI study. J Neurol Neurosurg Psychiatry. 2010;81(5):541–6.

    Article  PubMed  Google Scholar 

  11. Michaud TL, Su D, Siahpush M, Murman DL. The risk of incident mild cognitive impairment and progression to Dementia considering mild cognitive impairment subtypes. Dement Geriatr Cogn Dis Extra. 2017;7(1):15–29.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Scuteri A, Lakatta EG. Bringing prevention in geriatrics: evidences from cardiovascular medicine supporting the new challenge. Exp Gerontol. 2013;48(1):64–8.

    Article  PubMed  Google Scholar 

  13. Liu Y, Dong YH, Lyu PY, Chen WH, Li R. Hypertension-Induced Cerebral Small Vessel Disease leading to cognitive impairment. Chin Med J (Engl). 2018;131(5):615–9.

    Article  PubMed  Google Scholar 

  14. Rey-García J, Townsend RR. Large artery stiffness: a companion to the 2015 AHA science statement on arterial stiffness. Pulse (Basel). 2021;9(1–2):1–10.

    PubMed  Google Scholar 

  15. Canevelli M, Grande G, Lacorte E, Quarchioni E, Cesari M, Mariani C, Bruno G, Vanacore N. Spontaneous reversion of mild cognitive impairment to normal cognition: a systematic review of literature and meta-analysis. J Am Med Dir Assoc. 2016;17(10):943–8.

    Article  PubMed  Google Scholar 

  16. Angevaare MJ, Vonk JMJ, Bertola L, Zahodne L, Watson CW, Boehme A, Schupf N, Mayeux R, Geerlings MI, Manly JJ. Predictors of incident mild cognitive impairment and its course in a Diverse Community-based Population. Neurology. 2022;98(1):e15–26.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cannistraro RJ, Badi M, Eidelman BH, Dickson DW, Middlebrooks EH, Meschia JF. CNS small vessel disease. Neurology. 2019;92(24):1146–56.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, Lindley RI, O’Brien JT, Barkhof F, Benavente OR, Black SE, Brayne C, Breteler M, Chabriat H, Decarli C, de Leeuw FE, Doubal F, Duering M, Fox NC, Greenberg S, Hachinski V, Kilimann I, Mok V, Oostenbrugge R, Pantoni L, Speck O, Stephan BC, Teipel S, Viswanathan A, Werring D, Chen C, Smith C, van Buchem M, Norrving B, Gorelick PB, Dichgans M. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822–38.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Laurent S, Boutouyrie P. Recent advances in arterial stiffness and wave reflection in human hypertension. Hypertension. 2007;49(6):1202–6.

    Article  CAS  PubMed  Google Scholar 

  20. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13-e115.

  21. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366(9503):2112–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kmet L, Lee R. Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of FieldsAHFMRHTA Initiative20040213. HTA Initiative. 2004;2:2.

    Google Scholar 

  23. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Scuteri A, Manolio TA, Marino EK, Arnold AM, Lakatta EG. Prevalence of specific variant carotid geometric patterns and incidence of cardiovascular events in older persons. The Cardiovascular Health Study (CHS E-131). J Am Coll Cardiol. 2004;43(2):187–93.

    Article  PubMed  Google Scholar 

  25. Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial stiffness and Cardiovascular Risk in Hypertension. Circ Res. 2021;128(7):864–86.

    Article  CAS  PubMed  Google Scholar 

  26. Bulas J, Potocarova M, Kupcova V, Gaspar L, Wimmer G, Murin J. Central systolic blood pressure increases with aortic stiffness. Bratisl Lek Listy. 2019;120(12):894–8.

    CAS  PubMed  Google Scholar 

  27. Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in Health and Disease: JACC State-of-the-art review. J Am Coll Cardiol. 2019;74(9):1237–63.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chen H, Wu W, Fang W, Chen Z, Yan X, Chen Y, Wu S. Does an increase in estimated pulse wave velocity increase the incidence of hypertension? J Hypertens. 2021;39(12):2388–94.

    Article  CAS  PubMed  Google Scholar 

  29. Thorin-Trescases N, de Montgolfier O, Pinçon A, Raignault A, Caland L, Labbé P, Thorin E. Impact of pulse pressure on cerebrovascular events leading to age-related cognitive decline. Am J Physiol Heart Circ Physiol. 2018;314(6):H1214-1224.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Han F, Zhai FF, Li ML, Zhou LX, Ni J, Yao M, Jin ZY, Cui LY, Zhang SY, Zhu YC. Arterial stiffness is Associated with White Matter disruption and cognitive impairment: a community-based Cohort Study. J Alzheimers Dis. 2021;80(2):567–76.

    Article  CAS  PubMed  Google Scholar 

  31. Collin C, Revera M, Mazoyer B, Laurent S, Tzourio C, Boutouyrie P, Dufouil C. Arterial stiffness is associated with a higher risk of extend periventricular and deep white matter lesions according to gender in elderly. Artery Res. 2010;4(4):159.

    Article  Google Scholar 

  32. Park JH, Lee J, Kwon SU, Sung Kwon H, Hwan Lee M, Kang DW. Elevated pulse pressure and recurrent hemorrhagic stroke risk in stroke with cerebral microbleeds or Intracerebral Hemorrhage. J Am Heart Assoc. 2022;11(3):e022317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Jae SY, Heffernan KS, Kurl S, Kunutsor SK, Laukkanen JA. Association between estimated pulse wave velocity and the risk of stroke in middle-aged men. Int J Stroke. 2021;16(5):551–5.

    Article  PubMed  Google Scholar 

  34. Heffernan KS, Stoner L, Meyer ML, Loprinzi PD. Association between estimated pulse Wave Velocity and Cognitive Performance in older black and white adults in NHANES. J Alzheimers Dis. 2022;88(3):985–93.

    Article  CAS  PubMed  Google Scholar 

  35. Nilsson ED, Elmståhl S, Minthon L, Nilsson PM, Pihlsgård M, Tufvesson E, Nägga K. Nonlinear association between pulse wave velocity and cognitive function: a population-based study. J Hypertens. 2014;32(11):2152–7 discussion 7.

    Article  CAS  PubMed  Google Scholar 

  36. Meyer ML, Palta P, Tanaka H, Deal JA, Wright J, Knopman DS, Griswold ME, Mosley TH, Heiss G. Association of Central Arterial Stiffness and pressure pulsatility with mild cognitive impairment and dementia: the atherosclerosis risk in communities Study-Neurocognitive Study (ARIC-NCS). J Alzheimers Dis. 2017;57(1):195–204.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Snyder HM, Corriveau RA, Craft S, Faber JE, Greenberg SM, Knopman D, Lamb BT, Montine TJ, Nedergaard M, Schaffer CB, Schneider JA, Wellington C, Wilcock DM, Zipfel GJ, Zlokovic B, Bain LJ, Bosetti F, Galis ZS, Koroshetz W, Carrillo MC. Vascular contributions to cognitive impairment and dementia including Alzheimer’s disease. Alzheimers Dement. 2015;11(6):710–7.

    Article  PubMed  Google Scholar 

  38. Taniguchi Y, Fujiwara Y, Nofuji Y, Nishi M, Murayama H, Seino S, Tajima R, Matsuyama Y, Shinkai S. Prospective study of arterial stiffness and subsequent cognitive decline among Community-Dwelling Older Japanese. J Epidemiol. 2015;25(9):592–9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hajjar I, Goldstein FC, Martin GS, Quyyumi AA. Roles of arterial stiffness and blood pressure in hypertension-associated cognitive decline in healthy adults. Hypertens (0194911X). 2016;67(1):171–5.

    Article  CAS  Google Scholar 

  40. Pase MP, Beiser A, Himali JJ, Tsao C, Satizabal CL, Vasan RS, Seshadri S, Mitchell GF. Aortic stiffness and the risk of incident mild cognitive impairment and dementia. Stroke. 2016;47(9):2256–61.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nilsson ED, Elmståhl S, Minthon L, Pihlsgård M, Nilsson PM, Hansson O, Nägga K. No independent association between pulse wave velocity and dementia: a population-based, prospective study. J Hypertens. 2017;35(12):2462–7.

    Article  CAS  PubMed  Google Scholar 

  42. Watson NL, Sutton-Tyrrell K, Rosano C, Boudreau RM, Hardy SE, Simonsick EM, Najjar SS, Launer LJ, Yaffe K, Atkinson HH, Satterfield S, Newman AB. Arterial stiffness and cognitive decline in well-functioning older adults. J Gerontol Biol Sci Med Sci. 2011;66(12):1336–42.

    Article  Google Scholar 

  43. Menezes ST, Giatti L, Colosimo EA, Ribeiro ALP, Brant LCC, Viana MC, Cunha RS, Mill JG, Barreto SM. Aortic stiffness and age with cognitive performance decline in the ELSA-Brasil Cohort. J Am Heart Assoc. 2019;8(24):e013248.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Araghi M, Shipley MJ, Wilkinson IB, McEniery CM, Valencia-Hernández CA, Kivimaki M, Sabia S, Singh-Manoux A, Brunner EJ. Association of aortic stiffness with cognitive decline: Whitehall II longitudinal cohort study. Eur J Epidemiol. 2020;35(9):861–9.

    Article  PubMed  Google Scholar 

  45. Cooper LL, Woodard T, Sigurdsson S, van Buchem MA, Torjesen AA, Inker LA, Aspelund T, Eiriksdottir G, Harris TB, Gudnason V, Launer LJ, Mitchell GF. Cerebrovascular damage mediates relations between aortic stiffness and memory. Hypertension. 2016;67(1):176–82.

    Article  CAS  PubMed  Google Scholar 

  46. Mitchell GF, van Buchem MA, Sigurdsson S, Gotal JD, Jonsdottir MK, Kjartansson Ó, Garcia M, Aspelund T, Harris TB, Gudnason V, Launer LJ. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment susceptibility–Reykjavik study. Brain. 2011;134(Pt 11):3398–407.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Riba-Llena I, Jiménez-Balado J, Castañé X, Girona A, López-Rueda A, Mundet X, Jarca CI, Álvarez-Sabin J, Montaner J, Delgado P. Arterial stiffness is Associated with basal ganglia enlarged Perivascular spaces and Cerebral Small Vessel Disease load. Stroke. 2018;49(5):1279–81.

    Article  PubMed  Google Scholar 

  48. Maillard P, Mitchell GF, Himali JJ, Beiser A, Fletcher E, Tsao CW, Pase MP, Satizabal CL, Vasan RS, Seshadri S, DeCarli C. Aortic stiffness, increased White Matter Free Water, and altered Microstructural Integrity: a Continuum of Injury. Stroke. 2017;48(6):1567–73.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Scuteri A, Benetos A, Sierra C, Coca A, Chicherio C, Frisoni GB, Gasecki D, Hering D, Lovic D, Manios E, Petrovic M, Qiu C, Shenkin S, Tzourio C, Ungar A, Vicario A, Zaninelli A, Cunha PG. Routine assessment of cognitive function in older patients with hypertension seen by primary care physicians: why and how-a decision-making support fromthe working group on’hypertension and the brain’of the European Society ofHypertension and fromthe European GeriatricMedicine Society. J Hypertens. 2021;39(1):90–100.

    Article  CAS  PubMed  Google Scholar 

  50. Scuteri A, Modestino A, Frattari A, Di Daniele N, Tesauro M. Occurrence of hypotension in older participants. Which 24-hour ABPM parameter better correlate with? J Gerontol Biol Sci Med Sci. 2012;67(7):804–10.

    Article  Google Scholar 

  51. Scuteri A, Tesauro M, Guglini L, Lauro D, Fini M, Di Daniele N. Aortic stiffness and hypotension episodes are associated with impaired cognitive function in older subjects with subjective complaints of memory loss. Int J Cardiol. 2013;169(5):371–7.

    Article  PubMed  Google Scholar 

  52. Benetos A, Watfa G, Hanon O, Salvi P, Fantin F, Toulza O, Manckoundia P, Agnoletti D, Labat C, Gautier S. Pulse wave velocity is associated with 1-year cognitive decline in the elderly older than 80 years: the PARTAGE study. J Am Med Dir Assoc. 2012;13(3):239–43.

    Article  PubMed  Google Scholar 

  53. Lakatta EG, AlunniFegatelli D, Morrell CH, Fiorillo E, Orru M, Delitala A, Marongiu M, Schlessinger D, Cucca F, Scuteri A. Impact of stiffer arteries on the response to Antihypertensive Treatment: a longitudinal study of the SardiNIA Cohort. J Am Med Dir Assoc. 2020;21(6):720–5.

    Article  PubMed  Google Scholar 

  54. Chen Y, Shen F, Liu J, Yang GY. Arterial stiffness and stroke: de-stiffening strategy, a therapeutic target for stroke. Stroke Vasc Neurol. 2017;2(2):65–72.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Tsao CW, Himali JJ, Beiser AS, Larson MG, DeCarli C, Vasan RS, Mitchell GF, Seshadri S. Association of arterial stiffness with progression of subclinical brain and cognitive disease. Neurology. 2016;86(7):619–26.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Louka AM, Sagris D, Ntaios G. Immunity, vascular aging and stroke. Curr Med Chem. 2022;29(34):5510–21.

    Article  CAS  PubMed  Google Scholar 

  57. Wang M, Norman JE, Srinivasan VJ, Rutledge JC. Metabolic, inflammatory, and microvascular determinants of white matter disease and cognitive decline. Am J Neurodegener Dis. 2016;5(5):171–7.

    PubMed  PubMed Central  Google Scholar 

  58. Nilsson PM, Laurent S, Cunha PG, Olsen MH, Rietzschel E, Franco OH, Ryliškytė L, Strazhesko I, Vlachopoulos C, Chen CH, Boutouyrie P, Cucca F, Lakatta EG, Scuteri A. Characteristics of healthy vascular ageing in pooled population-based cohort studies: the global metabolic syndrome and artery REsearch Consortium. J Hypertens. 2018;36(12):2340–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Laurent S, Boutouyrie P, Cunha PG, Lacolley P, Nilsson PM. Concept of extremes in Vascular Aging. Hypertension. 2019;74(2):218–28.

    Article  CAS  PubMed  Google Scholar 

  60. Truswell AS, Kennelly BM, Hansen JD, Lee RB. Blood pressures of Kung bushmen in Northern Botswana. Am Heart J. 1972;84(1):5–12.

    Article  CAS  PubMed  Google Scholar 

  61. Oliver WJ, Cohen EL, Neel JV. Blood pressure, sodium intake, and sodium related hormones in the Yanomamo indians, a no-salt culture. Circulation. 1975;52(1):146–51.

    Article  CAS  PubMed  Google Scholar 

  62. Nilsson P. Early vascular aging (EVA): consequences and prevention. Vasc Health Risk Manag. 2008;4:547–52.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Nilsson PM, Lurbe E, Laurent S. The early life origins of vascular ageing and cardiovascular risk: the EVA syndrome. J Hypertens. 2008;26(6):1049–57.

    Article  CAS  PubMed  Google Scholar 

  64. Bilo G, Parati G. Rate of blood pressure changes assessed by 24 h ambulatory blood pressure monitoring: another meaningful index of blood pressure variability? J Hypertens. 2011;29(6):1054–8.

    Article  CAS  PubMed  Google Scholar 

  65. Palatini P, Casiglia E, Gąsowski J, Głuszek J, Jankowski P, Narkiewicz K, Saladini F, Stolarz-Skrzypek K, Tikhonoff V, Van Bortel L, Wojciechowska W, Kawecka-Jaszcz K. Arterial stiffness, central hemodynamics, and cardiovascular risk in hypertension. Vasc Health Risk Manag. 2011;7:725–39.

    Article  PubMed  PubMed Central  Google Scholar 

  66. O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension. 2005;46(1):200–4.

    Article  PubMed  Google Scholar 

  67. Vlachopoulos C, O'Rourke M, Nichols WW. McDonald's Blood Flow in Arteries. 2011.

  68. Liu Y, Xu K, Wu S, Qin M, Liu X. Value of estimated pulse wave velocity to identify left ventricular hypertrophy prevalence: insights from a general population. BMC Cardiovasc Disord. 2022;22(1):157.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Li C, Zhu Y, Ma Y, Hua R, Zhong B, Xie W. Association of cumulative blood pressure with Cognitive decline, Dementia, and Mortality. J Am Coll Cardiol. 2022;79(14):1321–35.

    Article  CAS  PubMed  Google Scholar 

  70. Brant L, Bos D, Araujo LF, Ikram MA, Ribeiro AL, Barreto SM. Microvascular endothelial function and cognitive performance: the ELSA-Brasil cohort study. Vasc Med. 2018;23(3):212–8.

    Article  PubMed  Google Scholar 

  71. Del Brutto OH, Mera RM, Recalde BY, Del Brutto VJ. Carotid intima-media thickness, Cognitive Performance and Cognitive decline in stroke-free Middle-aged and older adults. The Atahualpa Project. J Stroke Cerebrovasc Dis. 2020;29(2): 104576.

    Article  PubMed  Google Scholar 

  72. Li J, Guo L, Liu L, Liu C, Ye L, Song Y, Tang G, Wang B, Qin X, Zhang Y, Li J, Li P, Bao H, Wu Y, Xu X, Wang X, Huo Y, Huang X, Cheng X. Effect of age stratification on the association between carotid intima-media thickness and cognitive impairment in Chinese hypertensive patients: new insight from the secondary analysis of the China Stroke Primary Prevention Trial (CSPPT). Hypertens Res. 2021;44(11):1505–14.

    Article  CAS  PubMed  Google Scholar 

  73. Meyer ML, Klein BE, Klein R, Palta P, Sharrett AR, Heiss G, Nambi V, Wong TY, Tanaka H. Central arterial stiffness and retinal vessel calibers: the atherosclerosis risk in communities Study-Neurocognitive Study. J Hypertens. 2020;38(2):266–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Sacre JW, Magliano DJ, Zimmet PZ, Polkinghorne KR, Chadban SJ, Anstey KJ, Shaw JE. Associations of chronic kidney disease markers with cognitive function: a 12-Year Follow-Up study. J Alzheimers Dis. 2019;70(s1):S19–30.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Scuteri A, Rovella V, Alunni Fegatelli D, Tesauro M, Gabriele M, Di Daniele N. An operational definition of SHATS (systemic hemodynamic atherosclerotic syndrome): role of arterial stiffness and blood pressure variability in elderly hypertensive subjects. Int J Cardiol. 2018;263:132–7.

    Article  PubMed  Google Scholar 

  76. Kario K, Chirinos JA, Townsend RR, Weber MA, Scuteri A, Avolio A, Hoshide S, Kabutoya T, Tomiyama H, Node K, Ohishi M, Ito S, Kishi T, Rakugi H, Li Y, Chen CH, Park JB, Wang JG. Systemic hemodynamic atherothrombotic syndrome (SHATS) - coupling vascular disease and blood pressure variability: proposed concept from pulse of Asia. Prog Cardiovasc Dis. 2020;63(1):22–32.

    Article  PubMed  Google Scholar 

  77. Briet M, Collin C, Karras A, Laurent S, Bozec E, Jacquot C, Stengel B, Houillier P, Froissart M, Boutouyrie P. Arterial remodeling associates with CKD progression. J Am Soc Nephrol. 2011;22(5):967–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Kim ED, Meoni LA, Jaar BG, Shafi T, Linda Kao WH, Estrella MM, Parekh R, Sozio SM. association of arterial stiffness and central pressure with cognitive function in incident hemodialysis patients: the PACE study. Kidney Int Rep. 2017;2(6):1149–59.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Scuteri A, Coluccia R, Castello L, Nevola E, Brancati AM, Volpe M. Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure. Eur Heart J. 2009;30(12):1525–9.

    Article  PubMed  Google Scholar 

  80. Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation. 2005;112(15):2254–62.

    Article  PubMed  Google Scholar 

  81. Triantafyllidi H, Arvaniti C, Lekakis J, Ikonomidis I, Siafakas N, Tzortzis S, Trivilou P, Zerva L, Stamboulis E, Kremastinos DT. Cognitive impairment is related to increased arterial stiffness and microvascular damage in patients with never-treated essential hypertension. Am J Hypertens. 2009;22(5):525–30.

    Article  PubMed  Google Scholar 

  82. Briet M, Boutouyrie P, Laurent S, London GM. Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int. 2012;82(4):388–400.

    Article  PubMed  Google Scholar 

  83. van Popele NM, Grobbee DE, Bots ML, Asmar R, Topouchian J, Reneman RS, Hoeks AP, van der Kuip DA, Hofman A, Witteman JC. Association between arterial stiffness and atherosclerosis: the Rotterdam Study. Stroke. 2001;32(2):454–60.

    Article  PubMed  Google Scholar 

  84. Sawabe M, Takahashi R, Matsushita S, Ozawa T, Arai T, Hamamatsu A, Nakahara K, Chida K, Yamanouchi H, Murayama S, Tanaka N. Aortic pulse wave velocity and the degree of atherosclerosis in the elderly: a pathological study based on 304 autopsy cases. Atherosclerosis. 2005;179(2):345–51.

    Article  CAS  PubMed  Google Scholar 

  85. Amier RP, Marcks N, Hooghiemstra AM, Nijveldt R, van Buchem MA, de Roos A, Biessels GJ, Kappelle LJ, van Oostenbrugge RJ, van der Geest RJ, Bots ML, Greving JP, Niessen WJ, van Osch MJP, de Bresser J, van de Ven PM, van der Flier WM, Brunner-La Rocca HP, van Rossum AC. Hypertensive Exposure Markers by MRI in Relation to Cerebral Small Vessel Disease and Cognitive Impairment. JACC Cardiovasc Imaging. 2021;14(1):176 – 85.

  86. Palta P, Sharrett AR, Wei J, Meyer ML, Kucharska-Newton A, Power MC, Deal JA, Jack CR, Knopman D, Wright J, Griswold M, Tanaka H, Mosley TH, Heiss G. Central arterial stiffness is associated with structural brain damage and poorer cognitive performance: the ARIC study. J Am Heart Assoc. 2019;8(2):e011045.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Waldstein SR, Rice SC, Thayer JF, Najjar SS, Scuteri A, Zonderman AB. Pulse pressure and pulse wave velocity are related to cognitive decline in the Baltimore Longitudinal Study of Aging. Hypertension. 2008;51(1):99–104.

    Article  CAS  PubMed  Google Scholar 

  88. Tsao CW, Seshadri S, Beiser AS, Westwood AJ, Decarli C, Au R, Himali JJ, Hamburg NM, Vita JA, Levy D, Larson MG, Benjamin EJ, Wolf PA, Vasan RS, Mitchell GF. Relations of arterial stiffness and endothelial function to brain aging in the community. Neurology. 2013;81(11):984–91.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Poels MM, van Oijen M, Mattace-Raso FU, Hofman A, Koudstaal PJ, Witteman JC, Breteler MM. Arterial stiffness, cognitive decline, and risk of dementia: the Rotterdam study. Stroke. 2007;38(3):888–92.

    Article  PubMed  Google Scholar 

  90. Poels MM, Zaccai K, Verwoert GC, Vernooij MW, Hofman A, van der Lugt A, Witteman JC, Breteler MM, Mattace-Raso FU, Ikram MA. Arterial stiffness and cerebral small vessel disease: the Rotterdam scan study. Stroke. 2012;43(10):2637–42.

    Article  PubMed  Google Scholar 

  91. Zhong WJ, Cruickshanks KJ, Schubert CR, Carlsson CM, Chappell RJ, Klein BEK, Klein R, Acher CW. Pulse Wave velocity and cognitive function in older adults. Alzheimer Disease Assoc Disorders. 2014;28(1):44–9.

    Article  Google Scholar 

  92. Lin CH, Cheng HM, Wang JJ, Peng LN, Chen LK, Wang PN, Chen CH. Excess pressure but not pulse wave velocity is associated with cognitive function impairment: a community-based study. J Hypertens. 2022;40(9):1776–85.

    Article  CAS  PubMed  Google Scholar 

  93. Rensma SP, Stehouwer CDA, Van Boxtel MPJ, Houben A, Berendschot T, Jansen JFA, Schalkwijk CG, Verhey FRJ, Kroon AA, Henry RMA, Backes WH, Dagnelie PC, van Dongen M, Eussen S, Bosma H, Köhler S, Reesink KD, Schram MT, van Sloten TT. Associations of arterial stiffness with cognitive performance, and the role of microvascular dysfunction: the Maastricht Study. Hypertension. 2020;75(6):1607–14.

    Article  CAS  PubMed  Google Scholar 

  94. Ji C, Gao J, Huang Z, Chen S, Wang G, Wu S, Jonas JB. Estimated pulse wave velocity and cardiovascular events in Chinese. Int J Cardiol Hypertens. 2020;7:100063.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Vlachopoulos C, Terentes-Printzios D, Laurent S, Nilsson PM, Protogerou AD, Aznaouridis K, Xaplanteris P, Koutagiar I, Tomiyama H, Yamashina A, Sfikakis PP, Tousoulis D. Association of estimated pulse Wave Velocity with Survival: a secondary analysis of SPRINT. JAMA Netw Open. 2019;2(10):e1912831.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Greve SV, Blicher MK, Kruger R, Sehestedt T, Gram-Kampmann E, Rasmussen S, Vishram JK, Boutouyrie P, Laurent S, Olsen MH. Estimated carotid-femoral pulse wave velocity has similar predictive value as measured carotid-femoral pulse wave velocity. J Hypertens. 2016;34(7):1279–89.

    Article  CAS  PubMed  Google Scholar 

  97. He XW, Park J, Huang WS, Leng LH, Yu Y, Pei YB, Zhu G, Wu S. Usefulness of estimated pulse wave velocity for identifying prevalent coronary heart disease: findings from a general Chinese population. BMC Cardiovasc Disord. 2022;22(1):9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Nagai M, Dote K, Kato M, Sasaki S, Oda N, Kagawa E, Nakano Y, Yamane A, Higashihara T, Miyauchi S, Tsuchiya A. Visit-to-visit blood pressure variability and Alzheimer’s Disease: links and risks. J Alzheimers Dis. 2017;59(2):515–26.

    Article  PubMed  Google Scholar 

  99. Scuteri A, Morrell CH, Orru M, AlGhatrif M, Saba PS, Terracciano A, Ferreli LA, Loi F, Marongiu M, Pilia MG, Delitala A, Tarasov KV, Schlessinger D, Ganau A, Cucca F, Lakatta EG. Gender specific profiles of white coat and masked hypertension impacts on arterial structure and function in the SardiNIA study. Int J Cardiol. 2016;217:92–8.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Ruitenberg A, Den Heijer T, Bakker SLM, Van Swieten JC, Koudstaal PJ, Hofman A, Breteler MMB. Cerebral hypoperfusion and clinical onset of dementia: the Rotterdam study. Ann Neurol. 2005;57(6):789–94.

    Article  PubMed  Google Scholar 

  101. Wolters FJ, Zonneveld HI, Hofman A, van der Lugt A, Koudstaal PJ, Vernooij MW, Ikram MA. Cerebral perfusion and the risk of dementia: a Population-based study. Circulation. 2017;136(8):719–28.

    Article  PubMed  Google Scholar 

  102. Bateman GA, Levi CR, Schofield P, Wang Y, Lovett EC. The venous manifestations of pulse wave encephalopathy: windkessel dysfunction in normal aging and senile dementia. Neuroradiology. 2008;50(6):491–7.

    Article  PubMed  Google Scholar 

  103. Zhang Y, Agnoletti D, Xu Y, Wang JG, Blacher J, Safar ME. Carotid-femoral pulse wave velocity in the elderly. J Hypertens. 2014;32(8):1572–6 discussion 6.

    Article  CAS  PubMed  Google Scholar 

  104. Nilsson PM, Boutouyrie P, Laurent SP. Vascular Aging. Hypertension. 2009;54(1):3–10. https://doiorg.publicaciones.saludcastillayleon.es/10.1161/hypertensionaha.109.129114, https://dx.doi.org/10.1161/hypertensionaha.109.129114.

  105. Boutouyrie P, Tropeano AI, Asmar R, Gautier I, Benetos A, Lacolley P, Laurent S. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension. 2002;39(1):10–5.

    Article  CAS  PubMed  Google Scholar 

  106. Tougaard NH, Theilade S, Winther SA, Tofte N, Ahluwalia TS, Hansen TW, Rossing P, Frimodt-Møller M. Carotid-femoral pulse Wave Velocity as a risk marker for development of complications in type 1 diabetes Mellitus. J Am Heart Assoc. 2020;9(19):e017165.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Cheddani L, Radulescu C, Chaignon M, Karras A, Neuzillet Y, Duong JP, Tabibzadeh N, Letavernier E, Delahousse M, Haymann JP. From arterial stiffness to kidney graft microvasculature: mortality and graft survival within a cohort of 220 kidney transplant recipients. PLoS ONE. 2018;13(5): e0195928.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318–27.

    Article  PubMed  Google Scholar 

  109. Benetos A, Gautier S, Labat C, Salvi P, Valbusa F, Marino F, Toulza O, Agnoletti D, Zamboni M, Dubail D, Manckoundia P, Rolland Y, Hanon O, Perret-Guillaume C, Lacolley P, Safar ME, Guillemin F. Mortality and cardiovascular events are best predicted by low central/peripheral pulse pressure amplification but not by high blood pressure levels in elderly nursing home subjects: the PARTAGE (predictive values of blood pressure and arterial stiffness in Institutionalized very aged Population) study. J Am Coll Cardiol. 2012;60(16):1503–11.

    Article  PubMed  Google Scholar 

  110. Papaioannou TG, Protogerou AD, Stergiopulos N, Vardoulis O, Stefanadis C, Safar M, Blacher J. Total arterial compliance estimated by a novel method and all-cause mortality in the elderly: the PROTEGER study. Age (Dordr). 2014;36(3):9661.

    Article  PubMed  Google Scholar 

  111. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, Boutouyrie P, Cameron J, Chen CH, Cruickshank JK, Hwang SJ, Lakatta EG, Laurent S, Maldonado J, Mitchell GF, Najjar SS, Newman AB, Ohishi M, Pannier B, Pereira T, Vasan RS, Shokawa T, Sutton-Tyrell K, Verbeke F, Wang KL, Webb DJ, Willum Hansen T, Zoungas S, McEniery CM, Cockcroft JR, Wilkinson IB. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014;63(7):636–46.

    Article  PubMed  Google Scholar 

  112. Collins B, Bandosz P, Guzman-Castillo M, Pearson-Stuttard J, Stoye G, McCauley J, Ahmadi-Abhari S, Araghi M, Shipley MJ, Capewell S, French E, Brunner EJ, O’Flaherty M. What will the cardiovascular disease slowdown cost? Modelling the impact of CVD trends on dementia, disability, and economic costs in England and Wales from 2020–2029. PLoS ONE. 2022;17(6): e0268766.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  113. Selkoe DJ. Preventing Alzheimer’s disease. Science. 2012;337(6101):1488–92.

    Article  CAS  PubMed  Google Scholar 

  114. Greve SV, Laurent S, Olsen MH. Estimated pulse wave velocity calculated from age and mean arterial blood pressure. Pulse (Basel). 2017;4(4):175–9.

    Article  PubMed  Google Scholar 

  115. Laugesen E, Olesen KKW, Peters CD, Buus NH, Maeng M, Botker HE, Poulsen PL. Estimated pulse Wave Velocity is Associated with all-cause Mortality during 8.5 years follow-up in patients undergoing elective coronary angiography. J Am Heart Assoc. 2022;11(10):e025173.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Vamvakis A, Gkaliagkousi E, Lazaridis A, Grammatikopoulou MG, Triantafyllou A, Nikolaidou B, Koletsos N, Anyfanti P, Tzimos C, Zebekakis P, Douma S. Impact of intensive lifestyle treatment (Diet Plus Exercise) on endothelial and vascular function, arterial stiffness and blood pressure in stage 1 hypertension: results of the hintreat randomized controlled trial. Nutrients. 2020;12(5):1326.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Di Chiara T, Scaglione A, Corrao S, Argano C, Pinto A, Scaglione R. Education and hypertension: impact on global cardiovascular risk. Acta Cardiol. 2017;72(5):507–13.

    Article  PubMed  Google Scholar 

  118. Calimport SRG, Bentley BL, Stewart CE, Pawelec G, Scuteri A, Vinciguerra M, Slack C, Chen D, Harries LW, Marchant G, Fleming GA, Conboy M, Antebi A, Small GW, Gil J, Lakatta EG, Richardson A, Rosen C, Nikolich K, Wyss-Coray T, Steinman L, Montine T, de Magalhães JP, Campisi J, Church G. To help aging populations, classify organismal senescence. Science. 2019;366(6465):576–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  119. Hachinski V. Stroke and potentially preventable dementias Proclamation: updated World Stroke Day Proclamation. Stroke. 2015;46(11):3039–40.

    Article  PubMed  Google Scholar 

  120. Hachinski V, Einhäupl K, Ganten D, Alladi S, Brayne C, Stephan BCM, Sweeney MD, Zlokovic B, Iturria-Medina Y, Iadecola C, Nishimura N, Schaffer CB, Whitehead SN, Black SE, Østergaard L, Wardlaw J, Greenberg S, Friberg L, Norrving B, Rowe B, Joanette Y, Hacke W, Kuller L, Dichgans M, Endres M, Khachaturian ZS. Preventing dementia by preventing stroke: the Berlin Manifesto. Alzheimer’s Dementia. 2019;15(7):961–84.

    Article  PubMed  Google Scholar 

  121. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, Powers WJ, DeCarli C, Merino JG, Kalaria RN, Vinters HV, Holtzman DM, Rosenberg GA, Wallin A, Dichgans M, Marler JR, Leblanc GG. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment harmonization standards. Stroke. 2006;37(9):2220–41.

    Article  PubMed  Google Scholar 

  122. Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors).. Cochrane Handbook for Systematic Reviews of Interventions version 6.3. Cochrane, 2022.

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Acknowledgements

We would like to thank John Reynolds, MLIS, Jorge E. Perez, MLIS, and Thilani Samarakoon, PhD, MSIS of the Louis Calder Memorial Library at the University of Miami Miller School of Medicine for consulting on the search strategy and review methodology, and Roni Klass, PhD, at the University of Miami Writing Center.

Funding

Financial support received from the Evelyn F. McKnight Brain Institute, University of Miami.

Authors’ contributions: BA collected, synthesized, and analyzed studies. TA worked on the flowchart and tables. SM assisted in the review and writing. TR guided and assessed the process of reviewing and writing. All authors read and approved the final manuscript.

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  1. Department: University of Miami Miller School of Medicine, Evelyn F. McKnight Brain Institute, 1120 NW 14th St, Miami, Fl, 33136, USA

    Botagoz Aimagambetova, Taylor Ariko, Stacy Merritt & Tatjana Rundek

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BA collected, synthesized, and analyzed studies. TA worked on the flowchart and tables. SM assisted in the review and writing. TR guided and assessed the process of reviewing and writing. All authors read and approved the final manuscript.

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Aimagambetova, B., Ariko, T., Merritt, S. et al. Arterial stiffness measured by pulse wave velocity correlated with cognitive decline in hypertensive individuals: a systematic review. BMC Neurol 24, 393 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12883-024-03905-8

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