收缩压与老年高血压患者认知能力下降。
Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension.
机构信息
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Ann Fam Med. 2019 Mar;17(2):100-107. doi: 10.1370/afm.2367.
PURPOSE
Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged ≥75 years with or without complex health problems.
METHODS
We analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Stratified by SBP level in the year before baseline, we used mixed-effects linear regression models to evaluate the change from baseline to 1-year follow-up in outcome measures (Mini-Mental State Examination [MMSE], Groningen Activity Restriction Scale [GARS], and EQ-5D-3L). We adjusted for age, sex, and baseline MMSE/GARS/EQ-5D-3L scores and stratified for complex health problems as a proxy for frailty.
RESULTS
Participant (n = 1,266) age averaged 82.4 (SD 5) years, and 874 (69%) were women. For participants undergoing antihypertensive therapy (1,057; 83.5%) and with SBP <130 mm Hg, crude cognitive decline was 0.90 points MMSE, whereas in those with SBP >150 mm Hg, it was 0.14 points MMSE (ie, 0.76-point less decline; for trend = .013). Complex health problems modified the association of SBP with cognition; the association was seen in those with antihypertensive treatment ( for trend <.001), not in those without ( for trend = .13). Daily functioning/QoL did not differ across the strata of SBP or antihypertensive treatment.
CONCLUSIONS
Participants aged ≥75 years undergoing antihypertensive treatment, with SBP ≥130 mm Hg compared to <130 mm Hg, showed less cognitive decline after 1 year, without loss of daily functioning or QoL. This effect was strongest in participants with complex health problems. More studies should be conducted to determine if there is a causal relation and to understand the mechanism of the association observed.
目的
高血压试验常排除患有复杂健康问题的患者，缺乏普遍性。我们旨在确定接受降压治疗的患者的收缩压（SBP）是否与 75 岁以上患有或不患有复杂健康问题的患者在 1 年内认知/日常功能或生活质量（QoL）的变化相关。
方法
我们分析了一项基于人群的前瞻性队列研究（综合系统老年人护理[ISCOPE]）的数据，该研究随访时间为 1 年。根据基线前 1 年的 SBP 水平进行分层，我们使用混合效应线性回归模型来评估从基线到 1 年随访期间的结局指标（简易精神状态检查[MMSE]、格罗宁根活动限制量表[GARS]和 EQ-5D-3L）的变化。我们调整了年龄、性别和基线 MMSE/GARS/EQ-5D-3L 评分，并根据复杂健康问题（作为脆弱性的替代指标）进行分层。
结果
参与者（n=1266）年龄平均为 82.4（SD 5）岁，874 人（69%）为女性。对于接受降压治疗的参与者（1057 人；83.5%）和 SBP<130mmHg 的参与者，MMSE 认知下降为 0.90 分，而 SBP>150mmHg 的参与者为 0.14 分（即下降 0.76 分；趋势检验=0.013）。复杂健康问题改变了 SBP 与认知之间的关联；在接受降压治疗的参与者中观察到这种关联（趋势检验<.001），而在未接受降压治疗的参与者中则没有（趋势检验=0.13）。日常功能/QoL 在 SBP 或降压治疗的各分层中没有差异。
结论
与 SBP<130mmHg 相比，年龄≥75 岁接受降压治疗且 SBP≥130mmHg 的患者在 1 年后认知下降幅度较小，日常功能或 QoL 无损失。在患有复杂健康问题的患者中，这种效果最强。应进行更多研究以确定是否存在因果关系，并了解观察到的关联的机制。
Zotero 插件