Gilsanz Paola, Mayeda Elizabeth Rose, Glymour M Maria, Quesenberry Charles P, Mungas Dan M, DeCarli Charles, Dean Alexander, Whitmer Rachel A
From the Kaiser Permanente Division of Research (P.G., C.P.Q., A.D., R.A.W.), Oakland; Department of Epidemiology and Biostatistics (P.G., E.R.M., M.M.G., R.A.W.), University of California, San Francisco; Department of Epidemiology (E.R.M.), Fielding School of Public Health, University of California, Los Angeles; and Department of Neurology (D.M.M., C.D.), University of California Davis, Sacramento.
Neurology. 2017 Oct 31;89(18):1886-1893. doi: 10.1212/WNL.0000000000004602. Epub 2017 Oct 4.
To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women.
We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean age 32.7 years; early adulthood) and 1978-1985 (mean age 44.3 years; mid-adulthood) and were members as of January 1, 1996 (mean age 59.8 years). Hypertension categories based on measurements of blood pressure (BP) and change in hypertension categories between the 2 examinations (e.g., onset hypertension) were used to predict dementia incidence from January 1, 1996, to September 30, 2015. Cox proportional hazard models were adjusted for demographics, vascular comorbidities, and hypertension treatment; inverse probability weighting accounted for differential attrition between first BP measurement and start of follow-up.
A total of 532 individuals (9.4%) were diagnosed with dementia. Early adulthood hypertension was not associated with dementia, though effect estimates were elevated among women. Mid-adulthood hypertension was associated with 65% (95% confidence interval [CI] 1.25-2.18) increased dementia risk among women but not men. Onset of hypertension in mid-adulthood predicted 73% higher dementia risk in women (95% CI 1.24-2.40) compared to stable normotensive. There was no evidence that hypertension or changes in hypertension increased dementia risk among men.
Though midlife hypertension was more common in men, it was only associated with dementia risk in women. Sex differences in the timing of dementia risk factors have important implications for brain health and hypertension management.
评估成年早期和中年期高血压与男性及女性痴呆症之间的关联。
我们评估了一个多元化综合医疗保健系统中的5646名成员，他们在1964年至1973年（平均年龄32.7岁，成年早期）和1978 - 1985年（平均年龄44.3岁，中年期）接受了临床检查并拥有健康调查数据，且截至1996年1月1日（平均年龄59.8岁）仍是该系统成员。基于血压测量结果的高血压类别以及两次检查之间高血压类别的变化（例如，新发高血压）被用于预测1996年1月1日至2015年9月30日期间的痴呆症发病率。Cox比例风险模型针对人口统计学因素、血管合并症和高血压治疗进行了调整；逆概率加权法考虑了首次血压测量与随访开始之间的差异失访情况。
共有532人（9.4%）被诊断患有痴呆症。成年早期高血压与痴呆症无关联，尽管在女性中的效应估计值有所升高。中年期高血压与女性痴呆症风险增加65%（95%置信区间[CI] 1.25 - 2.18）相关，但与男性无关。与血压稳定正常的女性相比，中年期新发高血压的女性患痴呆症的风险高出73%（95% CI 1.24 - 2.40）。没有证据表明高血压或高血压变化会增加男性的痴呆症风险。
尽管中年期高血压在男性中更为常见，但仅与女性的痴呆症风险相关。痴呆症风险因素出现时间的性别差异对大脑健康和高血压管理具有重要意义。
