血压水平与老年女性认知障碍的关系：女性健康倡议记忆研究的前瞻性分析。
Association between blood pressure levels and cognitive impairment in older women: a prospective analysis of the Women's Health Initiative Memory Study.
机构信息
Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA (L Liu MD, E J Gracely PhD); Department of Social Sciences and Health Policy (K M Hayden PhD) and Department of Psychiatry and Behavioral Medicine (Prof S R Rapp PhD), Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA (N S May MD); Department of Cardiology, University Heart Center Graz, Medical University of Graz, Graz, Austria (B Haring MD); Department of Medicine, University of Wuerzburg, Wuerzburg, Germany (B Haring); Neurology, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA (Z Liu MD); Department of Epidemiology and Population Health and Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA (Prof V W Henderson MD); Departments of Population & Public Health Sciences and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (J-C Chen MD); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA (Prof S Wassertheil-Smoller PhD).
出版信息
Lancet Healthy Longev. 2022 Jan;3(1):e42-e53. doi: 10.1016/s2666-7568(21)00283-x. Epub 2022 Jan 5.
BACKGROUND
Whether blood pressure (BP), and at what level of controlled BP, reduces risk of cognitive impairment remains uncertain. We investigated the association of BP and hypertension treatment status with mild cognitive impairment and dementia in older women.
METHODS
We prospectively analysed a sample of 7207 community-dwelling women aged 65-79 years participating in the Women's Health Initiative Memory Study (WHIMS). Participants were recruited between May 28, 1996, and Dec 13, 1999, at 39 US clinical centres, and they were followed up until Dec 31, 2019. Cognitive function was assessed annually. Mild cognitive impairment and probable dementia were defined through a centralised adjudication process. BP was measured by trained and certified staff at baseline. Pulse pressure (PP) was calculated as systolic BP (SBP) minus diastolic BP. Hypertension was defined using the American Heart Association 2017 Guideline for High BP in Adults. Outcomes were (1) mild cognitive impairment, (2) probable dementia, and (3) cognitive loss (the combined endpoint of either mild cognitive impairment or probable dementia, or both). We estimated hazard ratios (HRs) to assess the association between hypertension, SBP, and PP with the risk of study outcomes using Cox proportional hazards regression models, with adjustment for key covariates.
FINDINGS
During a median follow-up of 9 years (IQR 6-15), 1132 (15·7%) participants were classified as mild cognitive impairment, 739 (10·3%) as probable dementia, and 1533 (21·3%) as cognitive loss. The incidence rates per 1000 person-years were 15·3 cases (95% CI 14·4-16·2) for mild cognitive impairment, 9·7 cases (9·0-10·4) for probable dementia, and 20·3 (19·3-21·3) for cognitive loss. Elevated SBP and PP were significantly associated with increased risk of mild cognitive impairment and cognitive loss (test for trends across SBP and PP strata, p<0·01). Individuals with hypertension, but with controlled SBP of less than 120 mm Hg did not have a significantly increased risk of mild cognitive impairment (HR 1·33, 95% CI 0·98-1·82, p=0·071), and of cognitive loss (1·09, 0·82-1·44, p=0·57) compared with normotension. Individuals on anti-hypertensive treatment with PP of less than 50 mm Hg did not have a significantly higher risk of mild cognitive impairment (1·26, 0·98-1·62, p=0·07) and of cognitive loss (1·17, 0·94-1·46, p=0·16). There were no significant associations between hypertension, SBP, or PP and probable dementia.
INTERPRETATION
Results of our study show significant associations of hypertension and elevated SBP and PP levels with risk of mild cognitive impairment and the combined endpoint of either mild cognitive impairment or probable dementia, suggesting that intensive control of hypertension, SBP, and PP can preserve cognitive health in older women.
FUNDING
National Heart, Lung, and Blood Institute, National Institutes of Health, and US Department of Health and Human Services.
背景
血压（BP）及其控制水平是否能降低认知障碍风险仍不确定。我们研究了血压和高血压治疗状况与老年女性轻度认知障碍和痴呆的关系。
方法
我们前瞻性分析了参加妇女健康倡议记忆研究（WHIMS）的 7207 名 65-79 岁的社区居住女性样本。参与者于 1996 年 5 月 28 日至 1999 年 12 月 13 日在 39 个美国临床中心招募，并随访至 2019 年 12 月 31 日。每年评估认知功能。通过中央裁决程序定义轻度认知障碍和可能的痴呆。血压由经过培训和认证的工作人员在基线时测量。脉搏压（PP）计算为收缩压（SBP）减去舒张压。高血压采用美国心脏协会 2017 年成人高血压指南定义。结局为（1）轻度认知障碍，（2）可能的痴呆，和（3）认知丧失（轻度认知障碍或可能的痴呆，或两者兼有）的联合终点。我们使用 Cox 比例风险回归模型估计风险比（HR），以评估高血压、SBP 和 PP 与研究结局的关系，调整了关键协变量。
结果
在中位随访 9 年（IQR 6-15）期间，1132 名（15.7%）参与者被分类为轻度认知障碍，739 名（10.3%）为可能的痴呆，1533 名（21.3%）为认知丧失。每 1000 人年的发病率分别为轻度认知障碍 15.3 例（95%CI 14.4-16.2）、可能的痴呆 9.7 例（9.0-10.4）和认知丧失 20.3 例（19.3-21.3）。升高的 SBP 和 PP 与轻度认知障碍和认知丧失风险增加显著相关（SBP 和 PP 分层的趋势检验，p<0.01）。患有高血压但 SBP 控制在 120mmHg 以下的个体，轻度认知障碍（HR 1.33，95%CI 0.98-1.82，p=0.071）和认知丧失（1.09，0.82-1.44，p=0.57）的风险无显著增加，与血压正常者相比。PP 低于 50mmHg 的抗高血压治疗个体，轻度认知障碍（1.26，0.98-1.62，p=0.07）和认知丧失（1.17，0.94-1.46，p=0.16）的风险无显著增加。高血压、SBP 和 PP 与可能的痴呆之间没有显著关联。
结论
我们的研究结果表明，高血压和 SBP 及 PP 水平升高与轻度认知障碍和轻度认知障碍或可能的痴呆的联合终点风险显著相关，提示强化高血压、SBP 和 PP 的控制可能有益于老年女性的认知健康。
资金
美国国立心肺血液研究所、美国国立卫生研究院和美国卫生与公众服务部。
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