Selbaek Geir, Stuebs Josephine, Engedal Knut, Hachinski Vladimir, Hestad Knut, Trevino Cathrine Selnes, Skjellegrind Håvard, Wedatilake Yehani, Strand Bjørn Heine
Norwegian National Centre for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
Front Aging Neurosci. 2022 Sep 15;14:931715. doi: 10.3389/fnagi.2022.931715. eCollection 2022.
High blood pressure is a well-established risk factor of dementia. However, the timing of the risk remains controversial. The aim of the present study was to compare trajectories of systolic blood pressure (SBP) over a 35-year follow-up period in the Health Survey in Trøndelag (HUNT) from study wave 1 to 4 in people with and without a dementia diagnosis at wave 4 (HUNT4). This is a retrospective cohort study of participants aged ≥ 70 years in HUNT4, where 9,720 participants were assessed for dementia. In the HUNT study all residents aged ≥ 20 years have been invited to four surveys: HUNT1 1984-86, HUNT2 1995-97, HUNT3 2006-08 and HUNT4 2017-19. The study sample was aged 70-102 years (mean 77.6, 6.0) at HUNT4, 54% were women and 15.5% had dementia, 8.8% had Alzheimer's disease (AD), 1.6% had vascular dementia (VaD) and 5.1% had other types of dementia. Compared to those without dementia at HUNT4, those with dementia at HUNT4 had higher SBP at HUNT1 and HUNT2, but lower SBP at HUNT4. These differences at HUNT1 and 2 were especially pronounced among women. Results did not differ across birth cohorts. For dementia subtypes at HUNT4, the VaD group had a higher SBP than the AD group at HUNT2 and 3. Age trajectories in SBP showed that the dementia group experienced a steady increase in SBP until 65 years of age and a decrease from 70 to 90 years. SBP in the no- dementia group increased until 80 years before it leveled off from 80 to 90 years. The present study confirms findings of higher midlife SBP and lower late-life SBP in people with dementia. This pattern may have several explanations and it highlights the need for close monitoring of BP treatment in older adults, with frequent reappraisal of treatment needs.
高血压是痴呆症公认的风险因素。然而，该风险出现的时间仍存在争议。本研究的目的是比较在特隆赫姆健康调查（HUNT）中，从第1轮研究到第4轮研究的35年随访期内，在第4轮研究（HUNT4）时有或没有痴呆症诊断的人群的收缩压（SBP）轨迹。这是一项对HUNT4中年龄≥70岁参与者的回顾性队列研究，其中9720名参与者接受了痴呆症评估。在HUNT研究中，所有年龄≥20岁的居民都被邀请参加四项调查：1984 - 1986年的HUNT1、1995 - 1997年的HUNT2、2006 - 2008年的HUNT3和2017 - 2019年的HUNT4。研究样本在HUNT4时年龄为70 - 102岁（平均77.6岁，标准差6.0），54%为女性，15.5%患有痴呆症，8.8%患有阿尔茨海默病（AD），1.6%患有血管性痴呆（VaD），5.1%患有其他类型的痴呆症。与HUNT4时没有痴呆症的人相比，HUNT4时有痴呆症的人在HUNT1和HUNT2时SBP较高，但在HUNT4时SBP较低。HUNT1和2时的这些差异在女性中尤为明显。不同出生队列的结果没有差异。对于HUNT4时的痴呆症亚型，VaD组在HUNT2和3时的SBP高于AD组。SBP的年龄轨迹表明，痴呆症组的SBP在65岁之前稳步上升，在70至90岁之间下降。无痴呆症组的SBP在80岁之前上升，在80至90岁之间趋于平稳。本研究证实了痴呆症患者中年时SBP较高而晚年时SBP较低的研究结果。这种模式可能有多种解释，它突出了对老年人血压治疗进行密切监测以及频繁重新评估治疗需求的必要性。
