Zhou Rong, Wang Yanyu, Gao Ling, Dang Liangjun, Shang Suhang, Hu Ningwei, Peng Wei, Zhao Yi, Wei Shan, Yuan Ye, Gao Fan, Wang Jin, Qu Qiumin
Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
J Neurol Sci. 2023 Apr 15;447:120613. doi: 10.1016/j.jns.2023.120613. Epub 2023 Mar 11.
It has been known that pulse pressure (PP) is a risk factor for cardiovascular disease and stroke, however, the relationship between PP and cognitive impairment is unclear.
This was a community-based cohort study. Participates were followed-up for 4 years and new-onset cognitive impairment was diagnosed. Multivariable logistic regression and restricted cubic spline (RCS) were used to investigate the relationship between PP and cognitive impairment. Propensity score matching (PSM) and sensitivity analysis among ApoEε4 non-carriers were performed to confirm the results.
1462 participants were included at baseline and 1173 completed the follow-up. There were 42 (3.5%) new-onset cognitive impairment of whom 31 were diagnosed with MCI and 11 with dementia during the follow-up. Multivariable logistic regression analysis showed that PP was positively associated with cognitive impairment (OR = 2.853, 95% CI 1.079-7.548, p = 0.035), and RCS suggested a non-linear relationship (P = 0.034). The risk of cognitive impairment merely changed when the PP was below about 46.7 mmHg and increased rapidly thereafter. After the covariates were well balanced using PSM (standardized mean differences <0.1 for all covariates), logistic regression analysis revealed the risk of cognitive impairment was still higher for those with high PP (OR = 3.369, 95% CI 1.202-9.441, p = 0.021). Sensitivity analysis showed consistent results with primary analysis.
PP is associated with cognitive impairment in a non-linear manner among middle-aged and elderly. The risk of cognitive impairment increases rapidly when PP exceeds about 46.7 mmHg, which may be informative for subsequent research of PP control ranges.
已知脉压（PP）是心血管疾病和中风的危险因素，然而，PP与认知障碍之间的关系尚不清楚。
这是一项基于社区的队列研究。对参与者进行了4年的随访，并诊断出新发认知障碍。采用多变量逻辑回归和受限立方样条（RCS）来研究PP与认知障碍之间的关系。进行倾向得分匹配（PSM）和ApoEε4非携带者的敏感性分析以证实结果。
基线时纳入了1462名参与者，1173名完成了随访。随访期间有42例（3.5%）新发认知障碍，其中31例被诊断为轻度认知障碍（MCI），11例被诊断为痴呆。多变量逻辑回归分析显示，PP与认知障碍呈正相关（OR = 2.853，95%CI 1.079 - 7.548，p = 0.035），RCS表明存在非线性关系（P = 0.034）。当PP低于约46.7 mmHg时，认知障碍风险仅略有变化，此后迅速增加。使用PSM使协变量达到良好平衡后（所有协变量的标准化均值差异<0.1），逻辑回归分析显示，PP高者的认知障碍风险仍然更高（OR = 3.369，95%CI 1.202 - 9.441，p = 0.021）。敏感性分析结果与初步分析一致。
在中老年人中，PP与认知障碍呈非线性相关。当PP超过约46.7 mmHg时，认知障碍风险迅速增加，这可能为后续PP控制范围的研究提供信息。
