Waldstein Shari R, Giggey Paul P, Thayer Julian F, Zonderman Alan B
Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Cir, Baltimore, MD 21250, USA.
Hypertension. 2005 Mar;45(3):374-9. doi: 10.1161/01.HYP.0000156744.44218.74. Epub 2005 Feb 7.
This investigation examined cross-sectional and longitudinal relations, both linear and nonlinear, of blood pressure (BP) and its interaction with demographic and lifestyle variables to a broad spectrum of cognitive functions. Eight hundred forty-seven participants (503 men and 344 women) from the Baltimore Longitudinal Study of Aging completed tests of verbal and nonverbal memory, attention, perceptuo-motor speed, executive functions, and confrontation naming, and clinical assessment of BP on 1 to 7 occasions over 11 years. Mixed-effects regression models, adjusted for age, education, gender, alcohol consumption, smoking status, depression scores, and use of antihypertensive medications, revealed nonlinear relations of systolic BP with longitudinal change on tests of nonverbal memory and confrontation naming; cognitive decline was apparent among older (80 years) individuals with higher systolic BP. Cross-sectional findings, across testing sessions, indicated moderated U- and J-shaped relations between BP and cognitive function. Both high and low diastolic BP were associated with poorer performance on tests of executive function and confrontation naming among less-educated persons; with tests of perceptuo-motor speed and confrontation naming among nonmedicated (antihypertensives) individuals; and with executive function among older individuals. Cross-sectional linear relations included higher systolic BP and poorer nonverbal memory in nondrinkers, and higher diastolic BP and poorer working memory among less-educated individuals. Results indicate that cross-sectional and longitudinal relations of BP to cognitive function are predominantly nonlinear and moderated by age, education, and antihypertensive medications. Careful monitoring and treatment of both high and low BP levels may be critical to the preservation of cognitive function.
本研究考察了血压（BP）及其与人口统计学和生活方式变量的相互作用与广泛认知功能之间的横断面和纵向关系，包括线性和非线性关系。来自巴尔的摩老年纵向研究的847名参与者（503名男性和344名女性）完成了言语和非言语记忆、注意力、感知运动速度、执行功能和对答命名测试，并在11年中接受了1至7次血压临床评估。在对年龄、教育程度、性别、饮酒量、吸烟状况、抑郁评分和抗高血压药物使用情况进行调整的混合效应回归模型显示，收缩压与非言语记忆和对答命名测试的纵向变化呈非线性关系；收缩压较高的老年（80岁）个体认知能力下降明显。跨测试阶段的横断面研究结果表明，血压与认知功能之间存在缓和的U型和J型关系。舒张压过高和过低均与受教育程度较低者执行功能和对答命名测试表现较差有关；与未服用抗高血压药物个体的感知运动速度和对答命名测试有关；与老年人的执行功能有关。横断面线性关系包括不饮酒者收缩压较高和非言语记忆较差，以及受教育程度较低者舒张压较高和工作记忆较差。结果表明，血压与认知功能的横断面和纵向关系主要是非线性的，并受年龄、教育程度和抗高血压药物的影响。对高血压和低血压水平进行仔细监测和治疗可能对维持认知功能至关重要。
