From the Medical School and Clinical Hospital (S.T.d.M., L.G., L.C.C.B., S.M.B.), Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Laboratory of Education in Environment and Health, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (R.H.G.).
Hypertension. 2021 Feb;77(2):672-681. doi: 10.1161/HYPERTENSIONAHA.120.16080. Epub 2020 Dec 14.
Hypertension, particularly in middle age, has been associated with worse cognitive function, but evidence is inconclusive. This study investigated whether hypertension, prehypertension, age, and duration of diagnosis, as well as blood pressure control, are associated with a decline in cognitive performance in ELSA-Brasil participants. This longitudinal study included 7063 participants, mean age 58.9 years at baseline (2008-2010), who attended visit 2 (2012-2014). Cognitive performance was measured in both visits and evaluated by the standardized scores of the memory, verbal fluency, trail B tests, and global cognitive score. The associations were investigated using linear mixed models. Hypertension and prehypertension at baseline were associated with decline in global cognitive score; being hypertension associated with reduction in memory test; and prehypertension with reduction in fluency test. Hypertension diagnose ≥55 years was associated with lower global cognitive and memory test scores, and hypertension diagnose <55 years with lower memory test scores. Duration of hypertension diagnoses was not associated with any marker of cognitive function decline. Among treated individuals, blood pressure control at baseline was inversely associated with the decline in both global cognitive and memory test scores. In this relatively young cohort, hypertension, prehypertension, and blood pressure control were independent predictors of cognitive decline in distinct abilities. Our findings suggest that both lower and older age of hypertension, but not duration of diagnosis, were associated with cognitive decline in different abilities. In addition to hypertension, prehypertension and pressure control might be critical for the preservation of cognitive function.
高血压，尤其是中年高血压，与认知功能下降有关，但证据尚不明确。本研究旨在探讨高血压、血压正常高值、年龄、诊断持续时间以及血压控制是否与 ELSA-Brasil 参与者的认知表现下降有关。这是一项纵向研究，共纳入 7063 名参与者，基线时平均年龄为 58.9 岁（2008-2010 年），在随访 2 时（2012-2014 年）接受了检查。在两次随访中都对认知表现进行了测量，并通过记忆、词语流畅性、B 型轨迹测试和总体认知评分的标准化评分来评估认知表现。使用线性混合模型来研究相关性。基线时的高血压和血压正常高值与总体认知评分的下降有关；高血压与记忆测试的下降有关；血压正常高值与流畅性测试的下降有关。诊断高血压≥55 岁与总体认知和记忆测试评分较低有关，而诊断高血压<55 岁与记忆测试评分较低有关。高血压的诊断持续时间与任何认知功能下降的标志物均无关。在接受治疗的人群中，基线时的血压控制与总体认知和记忆测试评分的下降呈负相关。在这个相对年轻的队列中，高血压、血压正常高值和血压控制是不同能力认知下降的独立预测因素。我们的研究结果表明，高血压的年龄较低和较老，而不是诊断持续时间，与不同能力的认知下降有关。除了高血压，血压正常高值和血压控制可能对认知功能的保持至关重要。
