Nutritional status of elderly hypertensive patients and its relation to the occurrence of cognitive impairment

Table 1 Hypertension classification

Separate into different kinds	Criteria for judgement
Grade 1 hypertension	SBP 140-159 mmHg and/or DBP 90-99 mmHg
Grade 2 hypertension	SBP 160 to 179 mmHg and/or DBP 100 to 109 mmHg
Grade 3 hypertension	SBP ≥ 180 mmHg and/or DBP ≥ 110 mmHg

SBP: Systolic blood pressure; DBP: Diastolic blood pressure.

Table 2 Baseline information, n (%)

Norm	Total cases (n = 200)	Modeling queue (n = 140)	Verification queue (n = 60)	t/χ2/F	P value
Distinguishing between the sexes				0.775	0.781
Male	93 (46.50)	66 (47.14)	27 (45.00)
Women	107 (53.50)	74 (52.86)	33 (55.00)
Age, year	71.49 ± 8.01	71.55 ± 8.03	71.44 ± 7.23	0.091	0.927
BMI, kg/m2	23.31 ± 2.54	23.15 ± 2.42	22.52 ± 2.61	1.648	0.101
Family history of hypertension				1.046	0.307
Yes	91 (45.50)	67 (47.86)	24 (40.00)
No	109 (54.50)	73 (52.14)	36 (60.00)
Course of hypertension, years	9.36 ± 2.70	9.24 ± 2.81	9.71 ± 3.10	1.051	0.295
High blood pressure classification				1.200	0.549
Level 1	107 (53.50)	73 (52.14)	34 (56.67)
Level 2	64 (32.00)	48 (34.29)	16 (26.67)
Level 3	29 (14.50)	19 (13.57)	10 (16.67)
Drinking history				0.577	0.448
Yes	78 (39.00)	57 (40.71)	21 (35.00)
No	122 (61.00)	83 (59.29)	39 (65.00)
Smoking history
Yes	109 (54.50)	76 (54.29)	33 (55.00)	0.009	0.926
No	91 (45.50)	64 (45.71)	27 (45.00)
defatted body weight, kg	54.92 ± 8.68	55.06 ± 8.92	54.46 ± 8.59	0.441	0.660
Upper arm muscle dimension, cm	25.01 ± 2.05	25.08 ± 2.11	24.88 ± 3.11	0.529	0.598
ALB, g/L	38.79 ± 5.66	38.82 ± 5.72	37.76 ± 3.62	1.325	0.187
Hb, g/L	133.62 ± 10.57	131.81 ± 10.92	134.47 ± 11.57	1.551	0.123
AST, U/L	20.44 ± 2.46	20.59 ± 2.51	20.35 ± 3.31	0.561	0.575
ALT, U/L	17.91 ± 2.93	17.95 ± 3.02	17.87 ± 2.81	0.175	0.861
Cr, mmol/L	80.23 ± 20.32	80.18 ± 20.42	80.43 ± 20.22	0.080	0.937
Hcy, mmol/L	20.67 ± 6.67	20.84 ± 6.83	20.42 ± 7.31	0.390	0.697
UA, μmol/L	260.66 ± 69.37	262.25 ± 70.15	259.68 ± 65.97	0.242	0.809
ALP, U/L	119.43 ± 19.60	119.18 ± 19.52	119.57 ± 19.71	0.129	0.897
Absolute lymphocytes	1.49 ± 0.60	1.49 ± 0.14	1.49 ± 0.65	0.000	1.000
TC, mmol/L	4.37 ± 1.01	4.08 ± 1.05	3.94 ± 0.81	0.922	0.358
TG, mmol/L	1.37 ± 0.82	1.44 ± 0.92	1.30 ± 0.62	1.078	0.283
LDL-C, mmol/L	1.20 ± 0.27	1.23 ± 0.23	1.15 ± 0.46	1.638	0.103
HDL-C, mmol/L	2.51 ± 0.70	2.53 ± 0.69	2.45 ± 0.77	0.725	0.469
MNA score, cent	21.77 ± 3.16	21.81 ± 3.52	21.74 ± 3.08	0.134	0.894

BMI: Body mass index; ALB: Albumin; Hb: Hemoglobin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; Cr: Creatinine; Hcy: Homocysteine; UA: Uric acid; ALP: Alkaline phosphatase; TC: Total cholesterol: TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; MNA: Mini-Nutritional Assessment Scale.

Table 3 Differences in the clinical profile of patients with different nutritional states, n (%)

Norm	Total cases (n = 140)	Malnutrition group (n = 26)	Malnutrition risk group (n = 42)	Normal nutritional status group (n = 72)	t/χ2/F	P value
Distinguishing between the sexes					0.541	0.763
Male	66 (47.14)	11 (42.31)	19 (45.24)	36 (50.00)
Women	74 (52.86)	15 (57.69)	23 (54.76)	36 (50.00)
Age, year	71.55 ± 8.03	71.42 ± 8.71	71.53 ± 8.62	71.69 ± 8.51	0.011	0.989
BMI, kg/m2	23.15 ± 2.42	20.63 ± 2.71	22.14 ± 2.27	24.69 ± 2.59	29.774	0.000
Family history of hypertension					0.243	0.886
Yes	67 (47.86)	13 (50.00)	21 (50.00)	33 (45.83)
No	73 (52.14)	13 (50.00)	21 (50.00)	39 (54.17)
Course of hypertension, year	9.24 ± 2.81	9.68 ± 3.12	9.62 ± 3.14	9.71 ± 3.10	0.011	0.989
High blood pressure classification					4.486	0.344
Level 1	73 (52.14)	12 (54.76)	23 (54.76)	38 (52.78)
Level 2	48 (34.29)	9 (26.19)	11 (26.19)	28 (38.89)
Level 3	19 (13.57)	5 (19.23)	8 (19.05)	6 (8.33)
Drinking history					1.784	0.410
Yes	57 (40.71)	10 (38.46)	14 (33.33)	33 (45.83)
No	83 (59.29)	16 (61.54)	28 (66.67)	39 (54.17)
Smoking history					0.006	0.997
Yes	76 (54.29)	14 (53.85)	23 (54.76)	39 (54.17)
No	64 (45.71)	12 (46.15)	19 (45.24)	33 (45.83)
Defatted body weight, kg	55.06 ± 8.92	54.33 ± 8.29	54.62 ± 8.36	55.71 ± 9.06	0.341	0.712
Upper arm muscle dimension, cm	25.08 ± 2.11	24.12 ± 3.11	24.92 ± 2.22	25.18 ± 2.81	1.465	0.235
ALB, g/L	38.82 ± 5.72	36.59 ± 3.77	38.14 ± 3.62	39.89 ± 4.92	6.047	0.003
Hb, g/L	131.81 ± 10.92	140.36 ± 10.07	123.58 ± 10.28	123.67 ± 12.19	23.286	0.000
AST, U/L	20.59 ± 2.51	20.33 ± 3.34	20.32 ± 3.36	20.35 ± 3.31	0.058	0.954
ALT, U/L	17.95 ± 3.02	17.85 ± 2.82	17.82 ± 2.84	17.87 ± 2.81	0.115	0.909
Cr, mmol/L	80.18 ± 20.42	82.09 ± 19.11	80.20 ± 19.37	79.03 ± 22.21	0.210	0.811
Hcy, mmol/L	20.84 ± 6.83	22.96 ± 6.85	20.86 ± 6.57	17.03 ± 11.52	4.551	0.012
UA, μmol/L	262.25 ± 70.15	250.37 ± 60.14	258.34 ± 60.52	266.11 ± 77.32	0.527	0.592
ALP, U/L	119.18 ± 19.52	120.18 ± 19.11	119.18 ± 19.31	118.18 ± 20.42	0.105	0.900
Absolute lymphocytes	1.49 ± 0.14	1.45 ± 0.04	1.46 ± 0.13	1.50 ± 0.12	2.684	0.072
TC, mmol/L	4.08 ± 1.05	3.88 ± 0.84	3.81 ± 0.90	4.16 ± 0.96	2.199	0.115
TG, mmol/L	1.44 ± 0.92	1.30 ± 0.66	1.32 ± 0.63	1.35 ± 0.58	0.075	0.928
LDL-C, mmol/L	1.23 ± 0.23	1.13 ± 0.32	1.13 ± 0.31	1.14 ± 0.31	0.018	0.982
HDL-C, mmol/L	2.53 ± 0.69	2.44 ± 0.78	2.46 ± 0.77	2.50 ± 0.73	0.076	0.927

BMI: Body mass index; ALB: Albumin; Hb: Hemoglobin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; Cr: Creatinine; Hcy: Homocysteine; UA: Uric acid; ALP: Alkaline phosphatase; TC: Total cholesterol: TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol.

Table 4 Comparison of clinical data between the two groups of patients with different cognitive functions in the modeling cohort, n (%)

Norm	Total cases (n = 140)	Hypertension combined with cognitive impairment group (n = 34)	Cognitively normal group with hypertension (n = 106)	t/χ2/F	P value
Distinguishing between the sexes				0.165	0.685
Male	66 (47.14)	15 (44.12)	51 (48.11)
Women	74 (52.86)	19 (55.88)	55 (51.89)
Age, year	71.55 ± 8.03	72.15 ± 8.15	70.15 ± 6.15	1.518	0.131
BMI, kg/m2	23.15 ± 2.42	22.56 ± 2.18	24.58 ± 2.98	3.648	0.000
Family history of hypertension				0.465	0.495
Yes	67 (47.86)	18 (52.94)	49 (46.23)
No	73 (52.14)	16 (47.06)	57 (53.77)
Course of hypertension, year	9.24 ± 2.81	10.84 ± 3.01	8.84 ± 2.67	3.683	0.000
High blood pressure classification				0.097	0.953
Level 1	73 (52.14)	18 (52.94)	55 (51.89)
Level 2	48 (34.29)	11 (32.35)	37 (34.91)
Level 3	19 (13.57)	5 (14.71)	14 (13.21)
Drinking history				0.114	0.735
Yes	57 (40.71)	13 (38.24)	44 (41.51)
No	83 (59.29)	21 (61.76)	62 (58.49)
Smoking history				0.332	0.564
Yes	76 (54.29)	17 (50.00)	59 (55.66)
No	64 (45.71)	17 (50.00)	47 (44.34)
Defatted body weight, kg	55.06 ± 8.92	54.18 ± 8.42	55.18 ± 9.43	0.552	0.582
Upper arm muscle dimension, cm	25.08 ± 2.11	24.81 ± 2.08	25.13 ± 2.05	0.789	0.431
ALB, g/L	38.82 ± 5.72	36.81 ± 4.51	39.71 ± 4.82	3.099	0.002
Hb, g/L	131.81 ± 10.92	128.98 ± 10.99	134.17 ± 11.31	2.344	0.021
AST, U/L	20.59 ± 2.51	20.81 ± 2.81	19.88 ± 2.48	1.841	0.067
ALT, U/L	17.95 ± 3.02	17.51 ± 2.91	18.05 ± 3.16	0.883	0.379
Cr, mmol/L	80.18 ± 20.42	82.18 ± 19.11	78.28 ± 19.52	1.019	0.310
Hcy, mmol/L	20.84 ± 6.83	21.13 ± 6.21	19.48 ± 6.28	1.337	0.184
UA, μmol/L	262.25 ± 70.15	256.81 ± 67.15	269.51 ± 50.31	1.176	0.242
ALP, U/L	119.18 ± 19.52	122.41 ± 20.51	102.62 ± 15.48	2.048	0.042
Absolute lymphocytes	1.49 ± 0.14	1.46 ± 0.13	1.53 ± 0.15	1.744	0.083
TC, mmol/L	4.08 ± 1.05	3.95 ± 1.01	4.21 ± 1.02	1.296	0.197
TG, mmol/L	1.44 ± 0.92	1.26 ± 0.53	1.56 ± 1.01	1.658	0.100
LDL-C, mmol/L	1.23 ± 0.23	1.21 ± 0.13	1.25 ± 0.11	1.763	0.080
HDL-C, mmol/L	2.53 ± 0.69	2.43 ± 0.61	2.61 ± 0.72	1.314	0.191
MNA score, cent	21.81 ± 3.52	19.21 ± 3.41	23.15 ± 3.14	6.234	0.000

BMI: Body mass index; ALB: Albumin; Hb: Hemoglobin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; Cr: Creatinine; Hcy: Homocysteine; UA: Uric acid; ALP: Alkaline phosphatase; TC: Total cholesterol: TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; MNA: Mini-Nutritional Assessment Scale.

Table 5 Independent variable assignments

Independent variable	Definitions and assignments
Distinguishing between the sexes	Men (1), women (0)
Age	Substitute the original value
BMI	Substitute the original value
Family history of hypertension	Yes (1), no (0)
Course of hypertension	Substitute the original value
High blood pressure classification	Level 3 (3), level 2 (2), level 1 (1)
Drinking history	Yes (1), no (0)
Smoking history	Yes (1), no (0)
Defatted body weight	Substitute the original value
Upper arm muscle dimension	Substitute the original value
ALB	Substitute the original value
Hb	Substitute the original value
AST	Substitute the original value
ALT	Substitute the original value
Cr	Substitute the original value
Hcy	Substitute the original value
UA	Substitute the original value
ALP	Substitute the original value
Absolute lymphocytes	Substitute the original value
TC	Substitute the original value
TG	Substitute the original value
LDL-C	Substitute the original value
HDL-C	Substitute the original value
MNA score	Substitute the original value

BMI: Body mass index; ALB: Albumin; Hb: Hemoglobin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; Cr: Creatinine; Hcy: Homocysteine; UA: Uric acid; ALP: Alkaline phosphatase; TC: Total cholesterol: TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; MNA: Mini-Nutritional Assessment Scale.

Table 6 Univariate analysis of factors influencing cognitive impairment

Considerations	β	SE	Wald χ2	P value	OR	95%CI
Distinguishing between the sexes	-0.161	0.396	0.165	0.685	0.851	0.392-1.851
Age	0.045	0.030	2.255	0.133	1.046	0.986-1.108
BMI	-0.167	0.072	5.350	0.021	0.846	0.734-0.975
Family history of hypertension	0.269	0.395	0.464	0.496	1.309	0.603-2.838
Course of hypertension	0.139	0.073	3.662	0.056	1.149	0.997-1.325
High blood pressure classification	0.009	0.276	0.001	0.975	1.009	0.587-1.733
Drinking history	-0.137	0.404	0.114	0.735	0.872	0.395-1.926
Smoking history	-0.227	0.395	0.332	0.565	0.797	0.367-1.727
Defatted body weight	-0.012	0.022	0.301	0.583	0.988	0.947-1.031
Upper arm muscle dimension	-0.077	0.098	0.626	0.429	0.926	0.764-1.121
ALB	-0.135	0.046	8.518	0.004	0.874	0.799-0.957
Hb	-0.042	0.018	5.264	0.022	0.959	0.925-0.994
AST	0.145	0.080	3.321	0.068	1.157	0.989-1.352
ALT	-0.057	0.065	0.780	0.377	0.945	0.832-1.072
Cr	0.011	0.010	1.042	0.307	1.011	0.990-1.031
Hcy	0.042	0.032	1.767	0.184	1.043	0.980-1.110
UA	-0.004	0.004	1.373	0.241	0.996	0.989-1.003
ALP	0.067	0.014	22.325	0.000	1.070	1.040-1.100
Absolute lymphocytes	0.734	1.388	0.279	0.597	2.082	0.137-31.614
TC	-0.242	0.195	1.532	0.216	0.785	0.536-1.151
TG	-0.384	0.234	2.700	0.100	0.681	0.431-1.077
LDL-C	-3.302	1.826	3.271	0.071	0.037	0.001-1.318
HDL-C	-0.397	0.290	1.882	0.170	0.672	0.381-1.186
MNA score	-0.405	0.086	22.357	0.000	0.667	0.564-0.789

OR: Odds ratio; CI: Confidence intervals; BMI: Body mass index; ALB: Albumin; Hb: Hemoglobin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; Cr: Creatinine; Hcy: Homocysteine; UA: Uric acid; ALP: Alkaline phosphatase; TC: Total cholesterol: TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; MNA: Mini-Nutritional Assessment Scale.

Table 7 Multifactorial analysis of factors influencing cognitive impairment

Considerations	β	SE	Wald χ2	P value	OR	95%CI
BMI	-0.187	0.076	6.041	0.014	0.830	0.715-0.963
ALB	-0.151	0.069	4.805	0.028	0.860	0.752-0.984
Hb	-0.063	0.030	4.432	0.035	0.939	0.886-0.996
ALP	0.071	0.018	14.927	0.000	1.074	1.036-1.113
MNA score	-0.447	0.108	17.279	0.000	0.640	0.518-0.790
Constant	19.006	6.728	7.980	0.005	179488137.767

OR: Odds ratio; CI: Confidence intervals; BMI: Body mass index; ALB: Albumin; Hb: Hemoglobin; ALP: Alkaline phosphatase; MNA: Mini-Nutritional Assessment Scale.

Table 8 Comparison of clinical data between the two groups of patients with different cognitive functions in the validation cohort, n (%)

Norm	Total cases (n = 60)	Hypertension combined with cognitive impairment group (n = 14)	Cognitively normal group with hypertension (n = 46)	t/χ2/F	P value
Distinguishing between the sexes				0.034	0.854
Male	27 (45.00)	6 (42.86)	21 (45.65)
Women	33 (55.00)	8 (57.14)	25 (54.35)
Age, year	71.44 ± 7.23	72.81 ± 8.14	70.66 ± 7.15	9.540	0.344
BMI, kg/m2	22.52 ± 2.61	20.12 ± 2.94	24.68 ± 2.41	5.885	0.000
Family history of hypertension				3.375	0.066
Yes	24 (40.00)	7 (50.00)	17 (36.96)
No	36 (60.00)	7 (50.00)	29 (63.04)
Course of hypertension, year	9.71 ± 3.10	10.29 ± 3.66	8.23 ± 3.14	2.068	0.043
High blood pressure classification				0.059	0.953
Level 1	34 (56.67)	8 (57.14)	26 (56.52)
Level 2	16 (26.67)	3 (18.75)	13 (28.26)
Level 3	10 (16.67)	3 (18.75)	7 (15.22)
Drinking history				0.066	0.798
Yes	21 (35.00)	5 (35.71)	16 (34.78)
No	39 (65.00)	9 (64.29)	30 (65.22)
Smoking history				0.034	0.854
Yes	33 (55.00)	8 (57.14)	25 (54.35)
No	27 (45.00)	6 (42.86)	21 (45.65)
Defatted body weight, kg	54.46 ± 8.59	54.65 ± 8.28	55.71 ± 9.12	0.389	0.699
Upper arm muscle dimension, cm	24.88 ± 3.11	25.01 ± 2.08	24.13 ± 2.35	1.257	0.214
ALB, g/L	37.76 ± 3.62	36.22 ± 3.58	39.71 ± 4.68	2.565	0.013
Hb, g/L	134.47 ± 11.57	123.27 ± 12.32	141.39 ± 11.27	5.156	0.000
AST, U/L	20.35 ± 3.31	20.21 ± 3.25	20.42 ± 3.40	0.204	0.839
ALT, U/L	17.87 ± 2.81	17.74 ± 2.81	17.91 ± 2.86	0.196	0.846
Cr, mmol/L	80.43 ± 20.22	82.11 ± 19.10	78.85 ± 22.14	0.497	0.621
Hcy, mmol/L	20.42 ± 7.31	22.92 ± 6.83	19.11 ± 7.38	1.719	0.091
UA, μmol/L	259.68 ± 65.97	252.63 ± 61.02	265.63 ± 75.27	0.589	0.558
ALP, U/L	119.57 ± 19.71	122.85 ± 18.57	102.41 ± 22.05	3.141	0.003
Absolute lymphocytes	1.49 ± 0.65	1.44 ± 0.62	1.53 ± 0.66	0.453	0.652
TC, mmol/L	3.94 ± 0.81	3.98 ± 0.78	4.14 ± 0.80	0.659	0.513
TG, mmol/L	1.30 ± 0.62	1.41 ± 0.59	1.32 ± 0.63	0.475	0.637
LDL-C, mmol/L	1.15 ± 0.46	1.16 ± 0.33	1.12 ± 0.35	0.379	0.706
HDL-C, mmol/L	2.45 ± 0.77	2.38 ± 0.82	2.47 ± 0.76	0.381	0.705
MNA score, cent	21.74 ± 3.08	17.92 ± 3.41	22.88 ± 2.61	5.785	0.000

BMI: Body mass index; ALB: Albumin; Hb: Hemoglobin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; Cr: Creatinine; Hcy: Homocysteine; UA: Uric acid; ALP: Alkaline phosphatase; TC: Total cholesterol: TG: Triglycerides; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; MNA: Mini-Nutritional Assessment Scale.