Vinyoles Ernest, De la Figuera Mariano, Gonzalez-Segura Diego
Primary Care Health Center La Mina, Barcelona, Spain.
Curr Med Res Opin. 2008 Dec;24(12):3331-9. doi: 10.1185/03007990802538724.
The aim of the COGNIPRES study was to analyze the prevalence of cognitive impairment in hypertensive individuals over 60 years of age, treated in primary care centres in the context of routine clinical practice. Degree of blood pressure control and treatment compliance, as well as other possible factors that influence cognitive function, were also evaluated.
An epidemiological, multicentre cross-sectional study was made. Demographic, clinical, therapeutic and blood pressure data for the first three hypertensive patients aged over 60 years seen in the primary care centre, and for the first patient visited at home by the physician were recorded. The study was carried out by 477 physicians in 333 primary care centres throughout Spain. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE), and therapeutic compliance was assessed using the Haynes-Sacket and Morisky-Green tests.
Of 1579 patients included in the study, 12.3% (95%CI 10.7-14.0) (n=195) had cognitive impairment. This was significantly associated with patients over 80 years of age (OR 4.97; 95%CI 2.98-8.29), exclusive home care (OR 1.84; 95%CI 1.19-2.83), anxiety (OR 1.84; 95%CI 1.19-2.83), stroke or transient ischemic attack (OR 4.37; 95%CI 2.81-6.78), Parkinson's disease (OR 8.15; 95%CI 2.54-26.12), essential tremor (OR 2.25; 95%CI 1.34-3.79), uncontrolled blood pressure (OR 0.60; 95%CI 0.39-0.94) and poor treatment compliance (OR 0.53; 95%CI 0.37-0.75). Overall, 28.3% of the patients showed controlled blood pressure, and 33.6% showed poor adherence to antihypertensive treatment.
In this study, the prevalence of cognitive impairment in hypertensive patients aged over 60 years was 12.3%. Less than a third of the patients had good blood pressure control. Compliance with therapy and good control of blood pressure are associated with better MMSE scores.
COGNIPRES研究的目的是分析在常规临床实践背景下，60岁以上高血压患者认知障碍的患病率。同时还评估了血压控制程度、治疗依从性以及其他可能影响认知功能的因素。
开展了一项流行病学多中心横断面研究。记录了在初级保健中心首诊的前三位60岁以上高血压患者以及医生首次家访患者的人口统计学、临床、治疗和血压数据。该研究由西班牙各地333个初级保健中心的477名医生进行。使用简易精神状态检查表（MMSE）评估认知障碍，使用海恩斯 - 萨克特和莫里西 - 格林测试评估治疗依从性。
在纳入研究的1579名患者中，12.3%（95%可信区间10.7 - 14.0）（n = 195）有认知障碍。这与80岁以上患者（比值比4.97；95%可信区间2.98 - 8.29）、仅接受家庭护理（比值比1.84；95%可信区间1.19 - 2.83）、焦虑（比值比1.84；95%可信区间1.19 - 2.83）、中风或短暂性脑缺血发作（比值比4.37；95%可信区间2.81 - 6.78）、帕金森病（比值比8.15；95%可信区间2.54 - 26.12）、特发性震颤（比值比2.25；95%可信区间1.34 - 3.79）、血压未得到控制（比值比0.60；95%可信区间0.39 - 0.94）以及治疗依从性差（比值比0.53；95%可信区间0.37 - 0.75）显著相关。总体而言，28.3%的患者血压得到控制，33.6%的患者对抗高血压治疗的依从性差。
在本研究中，60岁以上高血压患者认知障碍的患病率为12.3%。不到三分之一的患者血压控制良好。治疗依从性和良好的血压控制与更好的MMSE评分相关。
