Posner H B, Tang M-X, Luchsinger J, Lantigua R, Stern Y, Mayeux R
Gertrude H. Sergievsky Center, Columbia University, New York, NY 10032, USA.
Neurology. 2002 Apr 23;58(8):1175-81. doi: 10.1212/wnl.58.8.1175.
Hypertension at the age of 45 to 50 years may predispose to AD later in life. It is not known whether hypertension after age 65 years also contributes to AD risk, and its effect on cognitive function is also not fully understood.
Data were analyzed from 1,259 Medicare recipients free of dementia in a longitudinal study covering a 7-year period (1991 to 1998). The effect of hypertension was first examined in relationship to the risk for incident AD and then to incident vascular dementia (VaD) using Cox proportional hazards models. Changes in performance over time on tasks of memory, language, and visuospatial/cognitive function were compared in those with and without hypertension using generalized estimating equations.
Of the 1,259 subjects, 731 (58.1%) had a history of hypertension associated with diabetes, stroke, and heart disease. A history of hypertension was not associated with an increased risk for AD (rate ratio [RR] 0.9, 95% CI 0.7 to 1.3) but was associated with an increased risk for VaD (1.8 [1.0 to 3.2]). Hypertension was not associated with changes in memory, language, and general cognitive function in normal individuals over time. Compared with individuals with neither hypertension nor heart disease, those with hypertension or heart disease alone had no increase in risk for VaD. However, when both were present, there was a threefold increase in risk for VaD. A sixfold increase in risk was observed when both hypertension and diabetes were present.
Hypertension after age 65 years is not associated with AD and does not adversely affect memory, language, or general cognitive function. A history of hypertension may be an antecedent to VaD, particularly in the presence of heart disease or diabetes.
45至50岁的高血压可能会使个体在晚年易患阿尔茨海默病（AD）。目前尚不清楚65岁以后的高血压是否也会增加患AD的风险，其对认知功能的影响也尚未完全了解。
在一项为期7年（1991年至1998年）的纵向研究中，对1259名无痴呆症的医疗保险受益人的数据进行了分析。首先使用Cox比例风险模型研究高血压与AD发病风险的关系，然后研究其与血管性痴呆（VaD）发病风险的关系。使用广义估计方程比较了有高血压和无高血压者在记忆、语言和视觉空间/认知功能任务上随时间的表现变化。
在1259名受试者中，731名（58.1%）有高血压病史，且伴有糖尿病、中风和心脏病。高血压病史与AD风险增加无关（率比[RR]为0.9，95%置信区间为0.7至1.3），但与VaD风险增加有关（1.8[1.0至3.2]）。随着时间的推移，高血压与正常个体的记忆、语言和一般认知功能变化无关。与既无高血压也无心脏病的个体相比，仅患有高血压或心脏病的个体患VaD风险没有增加。然而，如果两者都存在，则患VaD的风险增加三倍。当高血压和糖尿病同时存在时，风险增加六倍。
65岁以后的高血压与AD无关，不会对记忆、语言或一般认知功能产生不利影响。高血压病史可能是VaD的一个先兆，特别是在伴有心脏病或糖尿病的情况下。
