Liang Xiaoniu, Shan Ying, Ding Ding, Zhao Qianhua, Guo Qihao, Zheng Li, Deng Wei, Luo Jianfeng, Tse Lap A, Hong Zhen
Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Front Neurol. 2018 Sep 4;9:664. doi: 10.3389/fneur.2018.00664. eCollection 2018.
To explore the association between blood pressure and cognition in older participants in the Shanghai Aging Study. Data were drawn from 3,327 participants at the baseline of Shanghai Aging Study. History of hypertension was inquired and confirmed from participants' medical records. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by research nurses in the early morning. Participants were diagnosed with "cognitive normal," "mild cognitive impairment (MCI)," or "dementia" by neurologists using DSM-IV and Petersen criteria. Multivariate logistic regression was used to evaluate the association between history of hypertension, duration of hypertension, SBP, DBP, or classification of blood pressure and cognitive function. Generalized linear model was used to assess the relation between duration of hypertension, SBP, or DBP and Mini Mental State Examination (MMSE). A significantly higher proportion of hypertension [78 (76.5%)] was found in participants with dementia than in those with MCI [347 (59.3%)] and cognitive normal [1,350 (51.1%)] ( < 0.0001). Participants with dementia had significantly higher SBP [157.6 (26.1) mmHg] than those with MCI [149.0 (23.7) mmHg] and cognitive normal [143.7 (22.6) mmHg] ( < 0.0001). After adjusting for sex, age, education, living alone, body mass index, anxiety, depression, heart disease, diabetes, and stroke, the likelihood of having dementia was positively associated with history of hypertension ( = 2.10; 95% CI: 1.22, 3.61), duration of hypertension ( = 1.02 per increment year; 95% CI: 1.01, 1.04), higher SBP ( = 1.14 per increment of 10 mmHg; 95% CI: 1.04, 1.25), higher DBP ( = 1.22 per increment of 10 mmHg; 95% CI: 1.02, 1.45), moderate hypertension ( = 2.09; 95% CI: 1.10, 3.99), or severe hypertension ( = 2.45; 95% CI: 1.20, 4.99). The MMSE score was inversely correlated to duration of hypertension (β = -0.0088 per increment year; 95% CI: -0.0158, -0.0018, = 0.0132), SBP (β = -0.0655 per increment of 10 mmHg; 95% CI: -0.1022, -0.0288, = 0.0005), and DBP (β = -0.1230 per increment of 10 mmHg; 95% CI: -0.1915, -0.0545, = 0.0004). Our results suggest that hypertension and high blood pressure may be potential risk factors for dementia. Blood pressure management for the elderly may be important for maintaining cognitive vitality.
在上海老龄化研究中，探讨老年参与者血压与认知之间的关联。数据来自上海老龄化研究基线期的3327名参与者。通过参与者的病历询问并确认高血压病史。研究护士在清晨测量收缩压（SBP）和舒张压（DBP）。神经科医生依据《精神疾病诊断与统计手册》第四版（DSM-IV）及彼得森标准，将参与者诊断为“认知正常”“轻度认知障碍（MCI）”或“痴呆”。采用多变量逻辑回归评估高血压病史、高血压病程、收缩压、舒张压或血压分级与认知功能之间的关联。使用广义线性模型评估高血压病程、收缩压或舒张压与简易精神状态检查表（MMSE）之间的关系。与MCI患者[347例（59.3%）]和认知正常者[1350例（51.1%）]相比，痴呆患者中高血压的比例显著更高[78例（76.5%）]（P<0.0001）。痴呆患者的收缩压[157.6（26.1）mmHg]显著高于MCI患者[149.0（23.7）mmHg]和认知正常者[143.7（22.6）mmHg]（P<0.0001）。在调整性别、年龄、教育程度、独居情况、体重指数、焦虑、抑郁、心脏病、糖尿病和中风因素后，患痴呆的可能性与高血压病史（比值比=2.10；95%置信区间：1.22，3.61）、高血压病程（每增加一年比值比=1.02；95%置信区间：1.01，1.04）、较高的收缩压（每增加10 mmHg比值比=1.14；95%置信区间：1.04，1.25）、较高的舒张压（每增加10 mmHg比值比=1.22；95%置信区间：1.02，1.45）、中度高血压（比值比=2.09；95%置信区间：1.10，3.99）或重度高血压（比值比=2.45；95%置信区间：1.20，4.99）呈正相关。MMSE评分与高血压病程（每增加一年β=-0.0088；95%置信区间：-0.0158，-0.0018，P=0.0132）、收缩压（每增加10 mmHgβ=-0.0655；95%置信区间：-0.1022，-0.0288，P=0.0005）和舒张压（每增加10 mmHgβ=-0.1230；95%置信区间：-0.1915，-0.0545，P=0.0004）呈负相关。我们的研究结果表明，高血压和高血压可能是痴呆的潜在危险因素。对老年人进行血压管理可能对维持认知活力很重要。
