Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham.
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Hypertens. 2022 Jul 1;40(7):1359-1368. doi: 10.1097/HJH.0000000000003151. Epub 2022 Jun 10.
Resistant hypertension is associated with increased risk of cognitive decline, stroke, and dementia. Lifestyle modification has been suggested to improve cognitive function through its salutary effects on vascular function.
Participants included 140 patients with resistant hypertension participating in the TRIUMPH trial. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA). Participants completed a 45-min cognitive test battery consisting of tests of Executive Functioning and Learning, Memory, and Processing Speed. Biomarkers of vascular [flow mediated dilation of the brachial artery (FMD)], microvascular, and cerebrovascular function were also collected, in addition to weight, fitness, and ambulatory blood pressure.
Participants averaged 63 years of age, 48% women, 59% black, and obese [mean BMI = 36 kg/m 2 (SD = 4)]. Cognitive performance improved across the entire cohort during the 4-month trial [ t -scores pretreatment = 48.9 (48, 50) vs. posttreatment = 50.0 (49, 51), P < 0.001]. Postintervention Executive Function/Learning composite performance was higher for participants in C-LIFE compared to SEPA ( d = 0.37, P = 0.039). C-LIFE intervention effects on Memory and Processing Speed were moderated by sex and baseline stroke risk, respectively ( P = 0.026 and P = 0.043 for interactions), such that males and participants with greater stroke risk showed the greatest cognitive changes. FMD [C-LIFE: +0.3% (-0.3, 1.0) vs. SEPA: -1.4% (-2.5, -0.3), P = 0.022], and microvascular function [C-LIFE: 97 (65, 130) vs. SEPA: 025 (-75, 23), P < 0.001] were improved in C-LIFE compared with SEPA, whereas cerebrovascular reactivity was not [C-LIFE: -0.2 (-0.4, 0) vs. SEPA: 0.1 (-0.2, 0.4), P = 0.197). Mediation analyses suggested that increased executive function/learning was associated with reduced ambulatory SBP levels secondary to weight loss [indirect effect: B = 0.25 (0.03, 0.71)].
Lifestyle modification individuals with resistant hypertension improves cognition, which appeared to be associated with reduced ambulatory SBP changes through weight loss. Cognitive improvements were accompanied by parallel improvements in endothelial and microvascular function.
高血压耐药与认知能力下降、中风和痴呆的风险增加有关。生活方式的改变被认为可以通过对血管功能的有益影响来改善认知功能。
参与者包括参加 TRIUMPH 试验的 140 名高血压耐药患者。参与者被随机分配到心脏康复为基础的生活方式计划（C-LIFE）或标准化教育和医生建议条件（SEPA）。参与者完成了一个 45 分钟的认知测试，包括执行功能和学习、记忆和处理速度测试。还收集了血管[肱动脉血流介导的扩张（FMD）]、微血管和脑血管功能的生物标志物，以及体重、健身和动态血压。
参与者的平均年龄为 63 岁，48%为女性，59%为黑人，肥胖[平均 BMI=36kg/m 2（SD=4）]。在整个试验期间，整个队列的认知表现都有所提高[预处理 t 评分=48.9（48，50）与治疗后 t 评分=50.0（49，51），P<0.001]。与 SEPA 相比，C-LIFE 组的执行功能/学习综合表现更高（d=0.37，P=0.039）。C-LIFE 对记忆和处理速度的干预效果分别受到性别和基线中风风险的调节（P=0.026 和 P=0.043 的交互作用），即男性和中风风险较高的参与者表现出最大的认知变化。与 SEPA 相比，FMD（C-LIFE：+0.3%（-0.3，1.0）与 SEPA：-1.4%（-2.5，-0.3），P=0.022）和微血管功能（C-LIFE：97（65，130）与 SEPA：025（-75，23），P<0.001）在 C-LIFE 中得到改善，而脑血管反应性没有改善[C-LIFE：-0.2（-0.4，0）与 SEPA：0.1（-0.2，0.4），P=0.197]。中介分析表明，由于体重减轻，执行功能/学习的增加与动态收缩压水平的降低有关[间接效应：B=0.25（0.03，0.71）]。
生活方式的改变可以改善高血压耐药患者的认知能力，这似乎与体重减轻导致的动态收缩压变化有关。认知能力的提高伴随着内皮和微血管功能的平行改善。
