Yang Wei, Luo Hongyu, Ma Yixin, Si Sicong, Zhao Huan
Department of Geriatric Medicine, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China.
Aging Dis. 2021 Jun 1;12(3):841-851. doi: 10.14336/AD.2020.1111. eCollection 2021 Jun.
Hypertension is a common comorbidity that contributes to the development of various cardiovascular disorders in elderly patients. Moreover, hypertension has been associated with cognitive decline and dementia. Cognitive impairment leads to increased morbidity and mortality in elderly patients with hypertension. However, previous studies investigating the association between blood pressure (BP), BP variability (BPV), and antihypertensive drug use and the risk of cognitive impairment in elderly patients with hypertension have reported inconsistent findings. Given the global burden of hypertension, the aging population, and the low quality of life associated with cognitive impairment, a more comprehensive understanding of the association between hypertension and cognitive decline is needed. In this review, we summarized the current preclinical evidence and clinical research regarding the association of BP control, BPV, and antihypertensive drug use and cognitive function. We particularly focused on the differences among categories of antihypertensive drugs. We concluded that the correlation of BP and risk of cognitive function is non-linear and dependent on a patient's age. Intensive BP control is generally not recommended, particularly for the oldest-old. Increased BPV and characteristics of orthostatic hypotension in the elderly also increase the risk of cognitive decline. The current evidence does not support one category of antihypertensive drugs as superior to others for preventing dementia in elderly patients with hypertension.
高血压是一种常见的合并症，可促使老年患者发生各种心血管疾病。此外，高血压还与认知能力下降和痴呆症有关。认知障碍会导致老年高血压患者的发病率和死亡率增加。然而，以往关于血压（BP）、血压变异性（BPV）、使用抗高血压药物与老年高血压患者认知障碍风险之间关联的研究结果并不一致。鉴于高血压的全球负担、人口老龄化以及与认知障碍相关的生活质量低下，需要更全面地了解高血压与认知能力下降之间的关联。在本综述中，我们总结了目前关于血压控制、BPV、使用抗高血压药物与认知功能之间关联的临床前证据和临床研究。我们特别关注了各类抗高血压药物之间的差异。我们得出结论，血压与认知功能风险之间的相关性是非线性的，并且取决于患者的年龄。一般不建议进行强化血压控制，尤其是对年龄最大的老年人。老年人BPV增加和体位性低血压特征也会增加认知能力下降的风险。目前的证据并不支持某一类抗高血压药物在预防老年高血压患者痴呆症方面优于其他药物。
