Yeung Sophie E, Loken Thornton Wendy
Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.
PLoS One. 2017 May 17;12(5):e0177424. doi: 10.1371/journal.pone.0177424. eCollection 2017.
Hypertension guidelines recommend home blood pressure (HBP) monitoring in adjunct to office blood pressure (OBP) for its greater reproducibility and prognostic utility in the prevention of cardiovascular outcomes, especially stroke. To date, the relationship between HBP and cognitive function remains unexplored.
We examined HBP as a cognitive predictor in a multi-ethnic group of community-dwelling adults aged 60 and over (N = 133) using neuropsychological measures and analyzed the data using multiple regression analyses. We also employed "everyday cognition" measures that have been found to have higher prognostic utility for real-world functioning than traditional cognitive tasks.
Good to perfect HBP monitoring compliance over seven days was achieved by 88.7% of the participants with superior reliability (ICC≥.96) to office readings. Higher home systolic BP and pulse pressure predicted worse processing speed, executive function, and everyday cognitive function, whereas lower home diastolic BP predicted worse everyday cognition. Office readings were similarly associated with everyday cognitive function but with no other cognitive measures.
Our findings are the first to validate HBP as a predictor of neuropsychological function in older adults beyond cognitive screening. Differential relationships among blood pressure variables and specific cognitive domains were observed. With proper standardization and training, we demonstrated that HBP can be obtained in a multi-ethnic community-dwelling older adult cohort. Our findings emphasize the importance of employing blood pressure and cognitive measures that are adequately sensitive to detect vascular-related cognitive impairment in a relatively healthy population. Implications regarding proper HBP measurement for hypertension management, cognitive health, and everyday function are discussed.
高血压指南建议将家庭血压（HBP）监测作为诊室血压（OBP）的辅助手段，因为其在预防心血管疾病结局，尤其是中风方面具有更高的可重复性和预后效用。迄今为止，HBP与认知功能之间的关系仍未得到探索。
我们使用神经心理学测量方法，在一个60岁及以上的多民族社区居住成年人组（N = 133）中，将HBP作为认知预测指标进行研究，并使用多元回归分析对数据进行分析。我们还采用了“日常认知”测量方法，已发现该方法对现实世界功能的预后效用高于传统认知任务。
88.7%的参与者在七天内实现了良好至完美的HBP监测依从性，其可靠性优于诊室读数（组内相关系数≥0.96）。较高的家庭收缩压和脉压预示着处理速度、执行功能和日常认知功能较差，而较低的家庭舒张压则预示着日常认知较差。诊室读数与日常认知功能也有类似关联，但与其他认知测量指标无关。
我们的研究结果首次验证了HBP可作为老年人认知筛查以外神经心理功能的预测指标。观察到血压变量与特定认知领域之间存在差异关系。通过适当的标准化和培训，我们证明了在一个多民族社区居住的老年人群体中可以获得HBP。我们的研究结果强调了采用对检测相对健康人群中血管相关认知障碍足够敏感的血压和认知测量方法的重要性。讨论了关于正确测量HBP对高血压管理、认知健康和日常功能的意义。
