Departments of Internal Medicine and Neurology, and University of Michigan Cognitive Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan.
Department of Internal Medicine, University of Michigan Medical School, and Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104754. doi: 10.1016/j.jstrokecerebrovasdis.2020.104754. Epub 2020 May 4.
It is unclear whether blood pressure (BP) is associated with cognition after stroke. We examined associations between systolic and diastolic BP (SBP, DBP), pulse pressure (PP), mean arterial pressure (MAP), and cognition, each measured 90 days after stroke.
Cross-sectional analysis of prospectively obtained data of 432 dementia-free subjects greater than or equal to 45 (median age, 66; 45% female) with stroke (92% ischemic; median NIH stroke score, 3 [IQR, 2-6]) from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in 2011-2013.
Modified Mini-Mental Status Examination (3MSE; range, 0-100).
Animal Fluency Test (AFT; range, 0-10) and Trail Making Tests A and B (number of correct items [range, 0-25]/completion time [Trails A: 0-180 seconds; Trails B: 0-300 second]). Linear or tobit regression adjusted associations for age, education, and race/ethnicity as well as variables significantly associated with BP and cognition.
Higher SBP, lower DBP, higher PP, and lower MAP each were associated with worse cognitive performance for all 4 tests (all P < .001). After adjusting for patient factors, no BP measures were associated with any of the 4 tests (all P > .05). Lower cognitive performance was associated with older age, less education, Mexican American ethnicity, diabetes, higher stroke severity, more depressive symptoms, and lower BMI. Among survivors with hypertension, anti-hypertensive medication use 90 days after stroke was significantly associated with higher AFT scores (P = .02) but not other tests (P > .15).
Stroke survivors' BP levels were not associated with cognitive performance at 90 days independent of sociodemographic and clinical factors.
目前尚不清楚血压（BP）与中风后认知功能之间是否存在关联。我们研究了中风后 90 天时收缩压（SBP）、舒张压（DBP）、脉压（PP）、平均动脉压（MAP）与认知之间的关联，每个参数均进行了测量。
2011-2013 年，我们对来自人群为基础的 Corpus Christi（BASIC）项目中 432 名无痴呆且年龄大于或等于 45 岁（中位年龄 66 岁；45%为女性）的中风患者（92%为缺血性中风；NIH 中风量表评分中位数为 3[四分位距，2-6]）前瞻性获取的数据进行了横断面分析。
改良简易精神状态检查（3MSE；范围，0-100）。
动物流畅性测验（AFT；范围，0-10）和连线测验 A 和 B（正确项数[范围，0-25]/完成时间[连线测验 A：0-180 秒；连线测验 B：0-300 秒]）。采用线性或 Tobit 回归，对年龄、教育和种族/民族以及与 BP 和认知显著相关的变量进行了调整，以评估各变量与结局之间的关联。
所有 4 项测试的 SBP 越高、DBP 越低、PP 越高、MAP 越低，认知表现越差（所有 P<0.001）。在校正患者因素后，没有 BP 测量值与 4 项测试中的任何一项相关（所有 P>0.05）。认知表现较差与年龄较大、教育程度较低、墨西哥裔美国人种族、糖尿病、中风严重程度较高、更多抑郁症状和较低 BMI 相关。在高血压幸存者中，中风后 90 天时抗高血压药物的使用与 AFT 评分较高显著相关（P=0.02），但与其他测试无关（P>0.15）。
中风幸存者的 BP 水平与 90 天时的认知表现无关，独立于社会人口学和临床因素。
