Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
Curr Cardiol Rep. 2020 Jun 19;22(8):63. doi: 10.1007/s11886-020-01312-2.
To review the research on the impact of blood pressure control on prevention of cognitive impairment and dementia.
Observational evidence has shown an association between hypertension and cognitive impairment. However, clinical trial results of blood pressure lowering have been inconclusive, likely due to inadequate cognitive assessment, blood pressure difference between groups, and follow-up duration. SPRINT-MIND showed a 19% reduction in mild cognitive impairment (14.6 vs 18.3 per 1000 person-years; HR, 0.81; 95% CI, 0.67-0.95), the earliest manifestation of dementia, with intensive blood pressure control. There was a statistically non-significant 17% reduction in the risk of probable dementia (HR 0.83, 95% CI 0.67-1.04). The progress of clinical trials testing the impact of blood pressure reduction on cardiovascular disease incidence has helped inform large trial testing of this intervention's impact on cognitive decline and dementia. SPRINT MIND demonstrated a positive effect of intensive blood pressure control on risk for mild cognitive impairment (MCI), and though the effect size was similar to MCI, the result was statistically non-significant possibly due to early termination of the intervention. Extension of follow-up may increase the number of new cases of dementia, producing a more conclusive result for dementia.
回顾血压控制对预防认知障碍和痴呆的影响的研究。
观察性证据表明高血压与认知障碍之间存在关联。然而，降压临床试验结果尚无定论，可能是由于认知评估不充分、组间血压差异以及随访时间不足。SPRINT-MIND 研究表明，强化降压可使轻度认知障碍（1000 人年中每 1000 人减少 14.6 例至 18.3 例；HR，0.81；95%CI，0.67-0.95）减少 19%，这是痴呆的最早表现。强化降压组发生可能痴呆的风险统计学上非显著降低 17%（HR 0.83，95%CI 0.67-1.04）。临床试验检测降压对心血管疾病发病率影响的进展，有助于为这项干预措施对认知衰退和痴呆影响的大型试验提供信息。SPRINT MIND 研究表明强化血压控制对轻度认知障碍（MCI）风险有积极影响，虽然效果大小与 MCI 相似，但结果统计学上无显著意义，可能是由于干预提前终止。延长随访时间可能会增加新的痴呆病例数量，从而产生更明确的痴呆结果。
