中国老年人血压与认知障碍之间的U型关联。
A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly.
作者信息
Lv Yue-Bin, Zhu Peng-Fei, Yin Zhao-Xue, Kraus Virginia Byers, Threapleton Diane, Chei Choy-Lye, Brasher Melanie Sereny, Zhang Juan, Qian Han-Zhu, Mao Chen, Matchar David Bruce, Luo Jie-Si, Zeng Yi, Shi Xiao-Ming
机构信息
Institute of Environmental Health and Related Products Safety, Chinese Center for Disease Control and Prevention, Beijing, China.
Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China.
出版信息
J Am Med Dir Assoc. 2017 Feb 1;18(2):193.e7-193.e13. doi: 10.1016/j.jamda.2016.11.011.
OBJECTIVES
Higher or lower blood pressure may relate to cognitive impairment, whereas the relationship between blood pressure and cognitive impairment among the elderly is not well-studied. The study objective was to determine whether blood pressure is associated with cognitive impairment in the elderly, and, if so, to accurately describe the association.
DESIGN
Cross-sectional data from the sixth wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2011.
SETTING
Community-based setting in longevity areas in China.
PARTICIPANTS
A total of 7144 Chinese elderly aged 65 years and older were included in the sample.
MEASURES
Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured, pulse pressure (PP) was calculated as (SBP) - (DBP) and mean arterial pressures (MAP) was calculated as 1/3(SBP) + 2/3(DBP). Cognitive function was assessed via a validated Mini-Mental State Examination (MMSE).
RESULTS
Based on the results of generalized additive models (GAMs), U-shaped associations were identified between cognitive impairment and SBP, DBP, PP, and MAP. The cutpoints at which risk for cognitive impairment (MMSE <24) was minimized were determined by quadratic models as 141 mm Hg, 85 mm Hg, 62 mm Hg, and 103 mm Hg, respectively. In the logistic models, U-shaped associations remained for SBP, DBP, and MAP but not PP. Below the identified cutpoints, each 1-mm Hg decrease in blood pressure corresponded to 0.7%, 1.1%, and 1.1% greater risk in the risk of cognitive impairment, respectively. Above the cutpoints, each 1-mm Hg increase in blood pressure corresponded to 1.2%, 1.8%, and 2.1% greater risk of cognitive impairment for SBP, DBP, and MAP, respectively.
CONCLUSION
A U-shaped association between blood pressure and cognitive function in an elderly Chinese population was found. Recognition of these instances is important in identifying the high-risk population for cognitive impairment and to individualize blood pressure management for cognitive impairment prevention.
目的
血压升高或降低可能与认知障碍有关，然而老年人血压与认知障碍之间的关系尚未得到充分研究。本研究的目的是确定血压是否与老年人的认知障碍相关，如果相关，则准确描述这种关联。
设计
2011年进行的中国老年健康长寿纵向调查（CLHLS）第六波的横断面数据。
地点
中国长寿地区的社区环境。
参与者
样本共纳入7144名65岁及以上的中国老年人。
测量指标
测量收缩压（SBP）和舒张压（DBP），计算脉压（PP）为（SBP） - （DBP），计算平均动脉压（MAP）为1/3（SBP） + 2/3（DBP）。通过经过验证的简易精神状态检查表（MMSE）评估认知功能。
结果
基于广义相加模型（GAM）的结果，在认知障碍与SBP、DBP、PP和MAP之间发现了U型关联。二次模型确定认知障碍风险（MMSE <24）最小化时的切点分别为141 mmHg、85 mmHg、62 mmHg和103 mmHg。在逻辑模型中，SBP、DBP和MAP仍呈U型关联，但PP不呈U型关联。在确定的切点以下，血压每降低1 mmHg，认知障碍风险分别增加0.7%、1.1%和1.1%。在切点以上，血压每升高1 mmHg，SBP、DBP和MAP的认知障碍风险分别增加1.2%、1.8%和2.1%。
结论
在中国老年人群中发现血压与认知功能之间存在U型关联。认识到这些情况对于识别认知障碍的高危人群以及为预防认知障碍进行个性化血压管理非常重要。
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