From the Department of Psychology (D.M.A., C.W., I.J.D.), University of Edinburgh, United Kingdom.
Centre for Cognitive Ageing and Cognitive Epidemiology (D.M.A., C.W., C.R.G., I.J.D.), University of Edinburgh, United Kingdom.
Hypertension. 2019 Apr;73(4):812-819. doi: 10.1161/HYPERTENSIONAHA.118.12164.
Higher early-life cognitive function is associated with better later-life health outcomes, including hypertension. Associations between higher prior cognitive function and less hypertension persist even when accounting for socioeconomic status, but socioeconomic status-hypertension gradients are more pronounced in women. We predicted that differences in hypertension development between sexes might be associated with cognitive function and its interaction with sex, such that higher early-life cognitive function would be associated with lower hypertension risk more in women than in men. We used accelerated failure time modeling with the National Longitudinal Study of Youth 1979. Cognitive function was assessed in youth, when participants were aged between 14 and 21 years. Of 2572 men and 2679 women who completed all assessments, 977 men and 940 women reported hypertension diagnoses by 2015. Socioeconomic status in youth and adulthood were investigated as covariates, as were components of adult socioeconomic status: education, occupational status, and family income. An SD of higher cognitive function in youth was associated with reduced hypertension risk (acceleration factor: ĉ=0.97; 95% CI, 0.96-0.99; P=0.001). The overall effect was stronger in women (sex×cognitive function: ĉ=0.97; 95% CI, 0.94-0.99; P=0.010); especially, higher functioning women were less at risk than their male counterparts. This interaction was itself attenuated by a sex by family income interaction. People with better cognitive function in youth, especially women, are less likely to develop hypertension later in life. Income differences accounted for these associations. Possible causal explanations are discussed.
早期认知功能较高与晚年健康结果较好相关，包括高血压。即使考虑到社会经济地位，先前认知功能较高与高血压较少之间的关联仍然存在，但女性的社会经济地位与高血压之间的梯度更为明显。我们预测，男女之间高血压发展的差异可能与认知功能及其与性别的相互作用有关，即较高的早期认知功能与女性而非男性的较低高血压风险的关联更大。我们使用国家青年纵向研究 1979 年的加速失效时间模型。认知功能在青年时期进行评估，此时参与者的年龄在 14 至 21 岁之间。在完成所有评估的 2572 名男性和 2679 名女性中，有 977 名男性和 940 名女性在 2015 年之前报告了高血压诊断。青年和成年时期的社会经济地位被作为协变量进行了研究，作为成年社会经济地位的组成部分：教育、职业地位和家庭收入。青年时期较高的认知功能的一个标准差与降低高血压风险相关（加速因子：ĉ=0.97；95%置信区间，0.96-0.99；P=0.001）。这种总体效应在女性中更强（性别×认知功能：ĉ=0.97；95%置信区间，0.94-0.99；P=0.010）；特别是，功能较高的女性比其男性对应者的风险更低。这种相互作用本身被性别与家庭收入的相互作用所减弱。青年时期认知功能较好的人，尤其是女性，以后患高血压的可能性较小。收入差异解释了这些关联。讨论了可能的因果解释。
