University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK.
Janssen, Hillsborough, NJ, USA.
J Alzheimers Dis. 2021;84(3):1373-1389. doi: 10.3233/JAD-210512.
Mid-life hypertension is an established risk factor for cognitive impairment and dementia and related to greater brain atrophy and poorer cognitive performance. Previous studies often have small sample sizes from older populations that lack utilizing multiple measures to define hypertension such as blood pressure, self-report information, and medication use; furthermore, the impact of the duration of hypertension is less extensively studied.
To investigate the relationship between hypertension defined using multiple measures and length of hypertension with brain measure and cognition.
Using participants from the UK Biobank MRI visit with blood pressure measurements (n = 31,513), we examined the cross-sectional relationships between hypertension and duration of hypertension with brain volumes and cognitive tests using generalized linear models adjusted for confounding.
Compared with normotensives, hypertensive participants had smaller brain volumes, larger white matter hyperintensities (WMH), and poorer performance on cognitive tests. For total brain, total grey, and hippocampal volumes, those with greatest duration of hypertension had the smallest brain volumes and the largest WMH, ventricular cerebrospinal fluid volumes. For other subcortical and white matter microstructural regions, there was no clear relationship. There were no significant associations between duration of hypertension and cognitive tests.
Our results show hypertension is associated with poorer brain and cognitive health however, the impact of duration since diagnosis warrants further investigation. This work adds further insights by using multiple measures defining hypertension and analysis on duration of hypertension which is a substantial advance on prior analyses-particularly those in UK Biobank which present otherwise similar analyses on smaller subsets.
中年高血压是认知障碍和痴呆的既定危险因素，与脑萎缩程度增加和认知表现下降有关。以前的研究通常样本量较小，且来自老年人群，缺乏利用血压、自我报告信息和药物使用等多种措施来定义高血压；此外，高血压持续时间的影响研究得还不够广泛。
研究使用多种措施定义的高血压和高血压持续时间与脑测量和认知之间的关系。
利用英国生物库 MRI 检查时的血压测量数据（n = 31513），我们使用广义线性模型，在调整混杂因素后，检查了高血压和高血压持续时间与脑容量和认知测试之间的横断面关系。
与血压正常者相比，高血压患者的脑容量较小，白质高信号（WMH）较大，认知测试的表现较差。对于总脑容量、总灰质容量和海马体容量，高血压持续时间最长的患者脑容量最小，WMH 最大，脑室脑脊液容量最大。对于其他皮质下和白质微观结构区域，没有明显的关系。高血压持续时间与认知测试之间没有显著关联。
我们的研究结果表明，高血压与较差的大脑和认知健康有关，但是高血压确诊后的持续时间的影响需要进一步研究。这项工作通过使用多种措施来定义高血压，并对高血压持续时间进行分析，这是对之前分析的重大推进，尤其是英国生物库中针对更小的子样本进行了类似的分析。
