Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China (C.L., Y.M., R.H., W.X.).
PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China (C.L., Y.M., R.H., H.W., W.X.).
Stroke. 2021 Oct;52(10):3249-3257. doi: 10.1161/STROKEAHA.120.033697. Epub 2021 Jun 25.
We aimed to test whether higher long-term blood pressure variability was associated with accelerated rate of cognitive decline and evaluate potential dose-response relationship.
Original survey data from the Health and Retirement Study and the English Longitudinal Study of Ageing were used. Standardized Z score of cognitive function was the main outcome measure. Visit-to-visit blood pressure SD, coefficient of variation, and variation independent of mean were used. Linear mixed model and restricted spline were applied to assess association and explore dose-response pattern. Segmented regression was used to analyze dose-response relationship and estimate turning point. Meta-analysis using random-effects model was conducted to pool results, with I2 used to test heterogeneity.
A total of 12 298 dementia-free participants were included (mean age: 64.6±8.6 years). Significant association was observed between blood pressure variability and cognitive decline. Each 10% increment in coefficient of variation of systolic and diastolic blood pressure was associated with accelerated global cognitive decline of 0.026 SD/y (95% CI, 0.016–0.036, P<0.001) and 0.022 SD/y (95% CI, 0.017–0.027, P<0.001), respectively. Nonlinear dose-response relationship was found (P<0.001 for nonlinearity), with clear turning point observed (P<0.001 for change in slopes).
Higher long-term blood pressure variability was associated with accelerated cognitive decline among general adults aged ≥50 years, with nonlinear dose-response relationship. Further randomized controlled trials are warranted to evaluate potential benefits of blood pressure variability-lowering strategies from a cognitive health perspective.
本研究旨在检验长期血压变异性与认知衰退速度加快之间是否存在关联，并评估潜在的剂量-反应关系。
本研究使用了健康与退休研究和英国老龄化纵向研究的原始调查数据。认知功能的标准化 Z 分数是主要的结局指标。采用血压的 visit-to-visit 标准差、变异系数和均值独立变异来评估。应用线性混合模型和限制样条来评估关联并探索剂量-反应模式。分段回归用于分析剂量-反应关系并估计转折点。采用随机效应模型进行荟萃分析，以汇总结果，并用 I²检验异质性。
共纳入 12298 名无痴呆症参与者（平均年龄：64.6±8.6 岁）。血压变异性与认知衰退之间存在显著关联。收缩压和舒张压变异系数每增加 10%，与全球认知衰退速度分别加快 0.026 SD/y（95%CI：0.016-0.036，P<0.001）和 0.022 SD/y（95%CI：0.017-0.027，P<0.001）相关。存在非线性剂量-反应关系（非线性检验 P<0.001），且观察到明显的转折点（斜率变化检验 P<0.001）。
在≥50 岁的一般成年人中，长期血压变异性较高与认知衰退速度加快相关，且存在非线性剂量-反应关系。需要进一步开展随机对照试验，从认知健康的角度评估降低血压变异性策略的潜在获益。
