VA Pacific Islands Health Care System, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA.
Neurology. 2013 Sep 3;81(10):888-95. doi: 10.1212/WNL.0b013e3182a351d4. Epub 2013 Aug 2.
To determine the associations between classes of antihypertensive medication use and the risk of cognitive impairment among elderly hypertensive men.
The Honolulu-Asia Aging Study is a prospective, community-based cohort study of Japanese American men conducted in Honolulu, Hawaii. We examined 2,197 participants (mean age 77 years at cohort entry, 1991-1993, followed through September 2010) with hypertension and without dementia or cognitive impairment at baseline, who provided information on medication use. Cognitive function was assessed at 7 standardized examinations using the Cognitive Abilities Screening Instrument (CASI). Cognitive impairment was defined as a CASI score <74.
A total of 854 men developed cognitive impairment (median follow-up, 5.8 years). β-Blocker use as the sole antihypertensive drug at baseline was consistently associated with a lower risk of cognitive impairment (incidence rate ratio [IRR] 0.69; 95% confidence interval [CI] 0.50-0.94), as compared with men not taking any antihypertensive medications, adjusting for multiple potential confounders. The use of diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or vasodilators alone was not significantly associated with cognitive impairment. Results were similar excluding those with cardiovascular disease or <1 year of follow-up, and additionally adjusting for pulse pressure, heart rate, baseline and midlife systolic blood pressure, and midlife antihypertensive treatment (IRR 0.65; 95% CI 0.45-0.94). The association between β-blocker use and cognitive impairment was stronger among men with diabetes, men aged >75 years, and those with pulse pressure ≥70 mm Hg.
β-blocker use is associated with a lower risk of developing cognitive impairment in elderly Japanese American men.
确定抗高血压药物类别的使用与老年高血压男性认知障碍风险之间的关联。
檀香山-亚洲老龄化研究是一项在夏威夷檀香山进行的、针对日本裔美国男性的前瞻性、社区为基础的队列研究。我们检查了 2197 名参与者（队列入组时的平均年龄为 77 岁，1991-1993 年，随访至 2010 年 9 月），这些参与者患有高血压，基线时无痴呆或认知障碍，提供了药物使用信息。使用认知能力筛查工具（CASI）在 7 次标准化检查中评估认知功能。认知障碍定义为 CASI 评分<74。
共有 854 名男性发生认知障碍（中位随访时间为 5.8 年）。与未服用任何抗高血压药物的男性相比，基线时仅使用β受体阻滞剂作为单一抗高血压药物与认知障碍风险降低相关（发病率比 [IRR] 0.69；95%置信区间 [CI] 0.50-0.94），调整了多种潜在混杂因素。单独使用利尿剂、钙通道阻滞剂、血管紧张素转换酶抑制剂或血管扩张剂与认知障碍无显著关联。排除心血管疾病或随访时间<1 年的患者后，结果相似，并且还调整了脉压、心率、基线和中年收缩压以及中年抗高血压治疗（IRR 0.65；95% CI 0.45-0.94）。β受体阻滞剂的使用与认知障碍之间的关联在患有糖尿病、年龄>75 岁和脉压≥70mmHg 的男性中更强。
β受体阻滞剂的使用与老年日本裔美国男性认知障碍的发生风险降低相关。
