Yamano S, Sawai F, Yamamoto Y, Sawai N, Minami S, Akai M, Nomura K, Takaoka M, Fukui R, Dohi K
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Jpn Circ J. 1999 Feb;63(2):79-84. doi: 10.1253/jcj.63.79.
To evaluate the relationship between blood pressure control and the progression of brain atrophy in the elderly, patients with essential hypertension and brain atrophy were longitudinally evaluated using computerized tomography (CT). The study evaluated 48 patients with essential hypertension aged 46-78 years, and 30 sex- and age-matched normotensive control subjects. The extent of brain atrophy as determined by caudate head index (CHI), the inverse cella media index (iCMI), and Evans' ratio (ER) was estimated twice at an interval of 5-9 years (mean, 6.9 years). The mean annual increases in CHI (deltaCHI), iCMI (delta iCMI), and ER (deltaER) were evaluated. Mean blood volume in the common carotid artery (BF) and the decrease in BF per year (deltaBF) were also determined. The deltaCHI, delta iCMI, and deltaER increased with age in the hypertensive subjects as well as the control group across all age groups evaluated. The deltaCHI, delta iCMI, and deltaER were significantly greater in the patients with essential hypertension in their 50 s as compared with the controls. In patients with essential hypertension aged 65 years or older, the deltaCHI, delta iCMI, and deltaER were significantly lower in the group in whom the blood pressure was controlled within the range of borderline hypertension than the groups in which it was controlled in the range of normal or mild hypertension. In the younger patients under the age of 65 with essential hypertension, blood pressure control did not affect the deltaCHI, delta iCMI, and deltaER. The deltaCHI, delta iCMI, and deltaER were significantly correlated with deltaBF in both groups. These findings indicate that control of systolic blood pressure within the range of borderline hypertension may delay the progression of brain atrophy in elderly patients with essential hypertension.
为评估老年患者血压控制与脑萎缩进展之间的关系，对原发性高血压合并脑萎缩患者采用计算机断层扫描（CT）进行纵向评估。该研究评估了48例年龄在46 - 78岁的原发性高血压患者，以及30例性别和年龄匹配的血压正常对照者。通过尾状核头指数（CHI）、中脑导水管指数倒数（iCMI）和埃文斯比率（ER）确定的脑萎缩程度每隔5 - 9年（平均6.9年）评估两次。评估了CHI（ΔCHI）、iCMI（ΔiCMI）和ER（ΔER）的年均增加值。还测定了颈总动脉的平均血容量（BF）以及每年BF的减少量（ΔBF）。在所有评估的年龄组中，高血压患者以及对照组的ΔCHI、ΔiCMI和ΔER均随年龄增加。与对照组相比，50多岁的原发性高血压患者的ΔCHI、ΔiCMI和ΔER显著更高。在65岁及以上的原发性高血压患者中，血压控制在临界高血压范围内的组的ΔCHI、ΔiCMI和ΔER显著低于血压控制在正常或轻度高血压范围内的组。在65岁以下的年轻原发性高血压患者中，血压控制不影响ΔCHI、ΔiCMI和ΔER。两组中的ΔCHI、ΔiCMI和ΔER均与ΔBF显著相关。这些发现表明，将收缩压控制在临界高血压范围内可能会延缓老年原发性高血压患者脑萎缩的进展。
