老年高血压患者认知功能障碍与心血管疾病事件的关系。
Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients.
机构信息
aAmerican Society of Hypertension Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA bDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi cDepartment of Orthopedics, Chikamorikai Medical Group, Kochi dTamaki Clinic eKijo Clinic fKuwabara Clinic gYokota Naika hEto Cardiology Clinic iKuroki Naika, Miyazaki, Japan.
出版信息
J Hypertens. 2014 Feb;32(2):423-31. doi: 10.1097/HJH.0000000000000025.
OBJECTIVES
This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients.
METHODS
We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points).
RESULTS
CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction.
CONCLUSION
Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.
目的
本研究旨在评估认知功能障碍是否可以作为一个标志物，与心血管疾病（CVD）事件的发生相关，而与老年高血压患者的动态血压（BP）或其他靶器官损伤（TOD）指数无关。
方法
我们招募了 585 名高血压患者（平均年龄 73 岁，41%为男性），这些患者可以活动，独立生活，且没有明显的临床痴呆症状。在基线时通过简易精神状态检查（MMSE）评估认知功能，前瞻性确定 CVD 事件（冠心病、中风、充血性心力衰竭和猝死）。认知功能障碍定义为 MMSE 评分最低四分位数（n = 183，中位数 24 分）。
结果
平均 2.8 年（1644 人年）后有 42 人发生 CVD 事件。与无 CVD 事件的患者相比，基线时发生 CVD 事件的患者认知功能障碍的发生率更高（57% vs. 29%；均 P <0.001）。调整夜间 SBP 和 TOD 证据（即白蛋白尿、心脏肥大和颈动脉内膜中层厚度（IMT））后，认知功能障碍与 CVD 事件相关，风险比为 2.5-2.9（均 P <0.01）。将 MMSE 纳入风险模型（包括年龄、估计肾小球滤过率和既往 CVD）可提高 C 统计量（从 0.691 提高至 0.741），并使净重新分类改善 17.6%（P = 0.02）。相比之下，纳入白蛋白尿、心脏肥大和颈动脉 IMT 对风险预测的改善作用不大。
结论
认知功能障碍是老年高血压患者 CVD 事件风险增加的一个独立标志物。
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