Department of Health Sciences, Division of Geriatric Medicine, Lund University, Malmö University Hospital, Malmö, Sweden.
Int J Gen Med. 2008 Nov 30;1:69-75. doi: 10.2147/ijgm.s4287.
Abnormal day-to-night blood pressure (BP) pattern have been found to be associated with cerebrovascular damage, yet studies of the elderly 80 years of age and above, for whom the risk pattern may be different due to ageing and age-associated diseases, are lacking. Ninety-seven 81-year-old men underwent ambulatory BP monitoring and were given six cognitive tests, 79 of the men completing the cognitive test battery. The odds ratio (OR) for performing one standard deviation below the mean on any cognitive test was calculated using a forward stepwise logistic regression model, confounding factors being controlled for. Groups defined in terms of day-to-night changes in BP were compared in this respect. Cognitive performance was lower (OR 3.6; P = 0.017) in the group usually described as dippers (10%-20% nocturnal drop in systolic BP [SBP]) as compared with nondippers (<10% drop). The tertile with the greatest SBP fall (10.6%-19.8%, a range considered as normal among middle aged) showed lowest cognitive performance (OR 4.7; P = 0.008) as compared with the middle tertile (5.1%-10.5% drop). The mean nocturnal fall in SBP was 7.4%, significantly greater in those with lower rather than higher cognitive performance. A nocturnal drop in SBP of >/=10% was associated with lower cognitive performance in these elderly men. The limits to normal dipping appear to be shifted in the direction of a lesser drop in the very elderly.
昼夜血压（BP）模式异常与脑血管损伤有关，但对于 80 岁及以上的老年人，由于年龄和与年龄相关的疾病，风险模式可能不同，因此缺乏相关研究。97 名 81 岁男性接受了动态血压监测，并进行了 6 项认知测试，其中 79 名男性完成了认知测试。使用向前逐步逻辑回归模型计算任何认知测试的平均值以下一个标准差的执行的优势比（OR），并控制混杂因素。在这方面，根据 BP 的昼夜变化定义的组进行了比较。与非杓型组（夜间收缩压 [SBP] 下降<10%）相比，通常被描述为杓型组（夜间 SBP 下降 10%-20%）的认知表现较低（OR 3.6；P=0.017）。SBP 下降最大的三分位数（10.6%-19.8%，在中年人群中被认为是正常范围）的认知表现最低（OR 4.7；P=0.008），而中间三分位数（5.1%-10.5%下降）。SBP 的平均夜间下降为 7.4%，认知表现较低的患者显著大于认知表现较高的患者。夜间 SBP 下降>=/10%与这些老年男性的认知表现较低相关。正常夜间下降的极限似乎朝着非常老年患者的下降幅度较小的方向转移。
