Department of Psychiatry, Center for Brain Health, New York University School of Medicine, New York, NY, USA; Department of Radiology, New York University School of Medicine, New York, NY, USA.
Neurobiol Aging. 2014 Jan;35(1):64-71. doi: 10.1016/j.neurobiolaging.2013.06.011. Epub 2013 Aug 19.
In hypertension (HTN), cerebral blood flow regulation limits are changed, and the threshold for blood pressure (BP) at which perfusion is safely maintained is higher. This shift may increase the brain's vulnerability to lower BP in subjects with vascular disease. We investigated whether longitudinal reduction in mean arterial pressure (MAP) was related to changes in cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease in a group of cognitively healthy elderly with and without HTN. The relationships among MAP, memory decline, and hippocampal atrophy were also examined. Seventy-seven subjects (age 63.4 ± 9.4, range 44-86 years; education 16.9 ± 2.1, range 10-22 years; 60% women) were assessed twice, 2 ± 0.5 years apart. At both time points, all subjects underwent full medical and neuropsychological evaluations, lumbar punctures, and magnetic resonance imaging examinations. Twenty-five subjects had HTN. Hyper- and normotensive subjects did not differ in their CSF biomarkers, hippocampal volumes (HipVs), or memory scores at baseline. In the entire study group, the increase in tau phosphorylated at threonine 181 (p-tau(181)) was associated with a decline in verbal episodic memory (β = -0.30, p = 0.01) and HipV reduction (β = -0.27, p = 0.02). However, longitudinal decrease in MAP was related to memory decline (β = 0.50, p = 0.01) and an increase in p-tau(181) (β = -0.50, p = 0.01) only in subjects with HTN. Our findings suggest that the hypertensive group may be sensitive to BP reductions.
在高血压（HTN）中，脑血流调节极限发生改变，血压维持灌注的安全阈值升高。这种转变可能会增加血管疾病患者的大脑对较低血压的脆弱性。我们研究了在一组认知健康的老年人群中，有无高血压，平均动脉压（MAP）的纵向降低是否与阿尔茨海默病的脑脊液（CSF）生物标志物变化有关。还检查了 MAP、记忆下降和海马萎缩之间的关系。77 名受试者（年龄 63.4±9.4 岁，范围 44-86 岁；教育程度 16.9±2.1 年，范围 10-22 年；60%为女性）在 2±0.5 年的时间间隔内接受了两次评估。在两次时间点，所有受试者都接受了全面的医学和神经心理学评估、腰椎穿刺和磁共振成像检查。25 名受试者患有高血压。在基线时，高血压和正常血压受试者的 CSF 生物标志物、海马体积（HipV）或记忆评分无差异。在整个研究组中，tau 第 181 位苏氨酸磷酸化（p-tau(181)）的增加与言语情景记忆（β=-0.30，p=0.01）和 HipV 减少（β=-0.27，p=0.02）呈负相关。然而，MAP 的纵向下降仅与高血压患者的记忆下降（β=0.50，p=0.01）和 p-tau(181)的增加（β=-0.50，p=0.01）有关。我们的发现表明，高血压组可能对血压降低敏感。
