{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:35:17Z","timestamp":1790854517089,"version":"4.1.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Our objective was to investigate the association between hypertension and concurrent impairments in mobility, cognition, and mood; the role of brain white matter hyperintensities in mediating this association; and the impact of these impairments on disability and mortality in elderly hypertensive individuals.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              \u2014Blood pressure, gait speed, digit symbol substitution test, and the Center for Epidemiological Studies Depression Scale were measured yearly (1992\u20131999) on 4700 participants in the Cardiovascular Health Study (age: 74.7, 58% women, 17% blacks, 68% hypertension, 3600 had brain magnetic resonance imaging in 1992\u20131993, survival data 1992\u20132005). Using latent profile analysis at baseline, we found that 498 (11%) subjects had concurrent impairments and 3086 (66%) were intact on all 3 measures. Between 1992 and 1999, 651 (21%) became impaired in all 3 domains. Hypertensive individuals were more likely to be impaired at baseline (odds ratio 1.23, 95% confidence interval 1.04 to 1.42,\n              <jats:italic>P<\/jats:italic>\n              =0.01) and become impaired during the follow-up (hazard ratio=1.3, 95% confidence interval 1.02 to 1.66,\n              <jats:italic>P<\/jats:italic>\n              =0.037). A greater degree of white matter hyperintensities was associated with impairments in the 3 domains (\n              <jats:italic>P<\/jats:italic>\n              =0.007) and mediated the association with hypertension (\n              <jats:italic>P<\/jats:italic>\n              =0.19 for hypertension after adjusting for white matter hyperintensities in the model, 21% hazard ratio change). Impairments in the 3 domains increased subsequent disability with hypertension (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). Hypertension mortality also was increased in those impaired (compared with unimpaired hypertensive individuals: HR=1.10, 95% confidence interval 1.04 to 1.17,\n              <jats:italic>P<\/jats:italic>\n              =0.004).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Hypertension increases the risk of concurrent impairments in mobility, cognition, and mood, which increases disability and mortality. This association is mediated in part by microvascular brain injury.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.110.978114","type":"journal-article","created":{"date-parts":[[2011,2,15]],"date-time":"2011-02-15T10:20:21Z","timestamp":1297765221000},"page":"858-865","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":185,"title":["Hypertension, White Matter Hyperintensities, and Concurrent Impairments in Mobility, Cognition, and Mood"],"prefix":"10.1161","volume":"123","author":[{"given":"Ihab","family":"Hajjar","sequence":"first","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lien","family":"Quach","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Yang","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo H.M.","family":"Chaves","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne B.","family":"Newman","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Mukamal","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Will","family":"Longstreth","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Inzitari","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); Division of Gerontology, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA (I.H., F.Y., K.M., L.A.L.); Center on Aging and Health, Johns Hopkins University, Baltimore, MD (P.H.M.C.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (A.B.N.); Division of Neurology, University of Washington, Seattle, WA ..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis A.","family":"Lipsitz","sequence":"additional","affiliation":[{"name":"From the Institute for Aging Research (I.H., L.Q., L.A.L., F.Y.), Hebrew SeniorLife, Harvard Medical School, Boston, MA (I.H., L.A.L., F.Y., K.M.); 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