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.
Ann Fam Med. 2019 Mar;17(2):100-107. doi: 10.1370/afm.2367.
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.
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.
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.
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.
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。
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。
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。
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。
