动态血压作为老年高血压患者脑萎缩和认知功能的独立决定因素

Ambulatory blood pressure as an independent determinant of brain atrophy and cognitive function in elderly hypertension.

作者信息

Nagai Michiaki, Hoshide Satoshi, Ishikawa Joji, Shimada Kazuyuki, Kario Kazuomi

机构信息

Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.

出版信息

J Hypertens. 2008 Aug;26(8):1636-41. doi: 10.1097/HJH.0b013e3283018333.

DOI:10.1097/HJH.0b013e3283018333

PMID:18622243

Abstract

OBJECTIVE

Recent studies have demonstrated a relationship between brain atrophy and hypertension. Systolic hypertension in the elderly has been found to be a risk factor for cognitive impairment. We studied the relationship of ambulatory blood pressure with brain atrophy and cognitive function.

METHODS

We performed ambulatory blood pressure monitoring and brain magnetic resonance imaging in 55 unmedicated elderly hypertensive patients (72.7 +/- 6.0 years old). The volume of total brain matter was measured using an intensity contour-mapping algorithm. Cognitive function was assessed by mini-mental state examination score.

RESULTS

Total brain matter volume and cognitive function were significantly correlated (r = 0.314, P = 0.02). Total brain matter volume was significantly negatively correlated with age (r = -0.365, P = 0.006), 24-h systolic blood pressure (r = -0.343, P = 0.01), awake systolic blood pressure (r = -0.278, P = 0.04) and sleep systolic blood pressure (r = -0.491, P = 0.0001), and significantly positively correlated with male sex (r = 0.493, P = 0.0001), body mass index (r = 0.282, P = 0.04) and nocturnal systolic blood pressure dipping (r = 0.323, P = 0.02). Mini-mental state examination score was significantly negatively correlated with age (r = -0.277, P = 0.04) and sleep systolic blood pressure (r = -0.360, P = 0.007), and significantly positively correlated with nocturnal systolic blood pressure dipping (r = 0.402, P = 0.002). In multiple linear regression analysis adjusted for age, sex, and body mass index, sleep systolic blood pressure (P = 0.009) was more significantly negatively associated with total brain matter volume than was either 24-h (P = 0.035) or awake (P = 0.020) systolic blood pressure.

CONCLUSIONS

In elderly hypertensive patients, absolute ambulatory systolic blood pressure level (particularly during sleep) and nocturnal dipping in systolic blood pressure were strong indicators of brain matter volume and cognitive function.

摘要

目的

近期研究表明脑萎缩与高血压之间存在关联。老年收缩期高血压已被发现是认知功能障碍的一个危险因素。我们研究了动态血压与脑萎缩及认知功能之间的关系。

方法

我们对55例未接受药物治疗的老年高血压患者（72.7±6.0岁）进行了动态血压监测和脑磁共振成像检查。使用强度轮廓映射算法测量全脑体积。通过简易精神状态检查评分评估认知功能。

结果

全脑体积与认知功能显著相关（r = 0.314，P = 0.02）。全脑体积与年龄（r = -0.365，P = 0.006）、24小时收缩压（r = -0.343，P = 0.01）、清醒时收缩压（r = -0.278，P = 0.04）和睡眠时收缩压（r = -0.491，P = 0.0001）显著负相关，与男性（r = 0.493，P = 0.0001）、体重指数（r = 0.282，P = 0.04）和夜间收缩压下降（r = 0.323，P = 0.02）显著正相关。简易精神状态检查评分与年龄（r = -0.277，P = 0.04）和睡眠时收缩压（r = -0.360，P = 0.007）显著负相关，与夜间收缩压下降（r = 0.402，P = 0.002）显著正相关。在对年龄、性别和体重指数进行校正的多元线性回归分析中，睡眠时收缩压（P = 0.009）比24小时收缩压（P = 0.035）或清醒时收缩压（P = 0.020）与全脑体积的负相关性更强。