Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, China.
Department of Neurology, Beijing Shijingshan Hospital, Shijingshan Teaching Hospital of Capital Medical University, China.
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107289. doi: 10.1016/j.jstrokecerebrovasdis.2023.107289. Epub 2023 Aug 4.
This study aimed to investigate the effects of intensive blood pressure control on cognitive function in elderly patients with cerebral small vessel disease (CSVD).
From May 2020 to June 2022, 140 outpatients and inpatients with CSVD and hypertension in the Department of Neurology of Beijing Shijingshan Hospital were selected. They were randomly divided into the standard and intensive blood pressure control groups, and the dosage of antihypertensive drugs was adjusted to reduce the blood pressure to the target level. The patients were followed up for 2 years. The medical records or data at "enrollment" and "2-year follow-up" were analyzed and evaluated. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate cognitive function. Cranial magnetic resonance imaging was performed to evaluate lacunar infarctions (LIs) and white matter hyperintensity (WMH). Multiple linear regression was used to analyze the correlation between MMSE scores and blood pressure, WMH, and LIs.
(1) The MMSE and MoCA scores in the standard group were significantly lower than those at enrollment. The WMH score in the standard group was significantly higher than that at enrollment. (2) After the 2-year follow-up, the 24-h systolic blood pressure (SBP), 24-h diastolic blood pressure (DBP), daytime mean SBP, daytime mean DBP, and nighttime mean SBP in the two groups significantly decreased, which had significant statistical significance (P < 0.05). (3) The correlation between blood pressure and MMSE score was analyzed using multiple linear regression analysis. The WMH score, LIs, 24-h SBP, and 24-h DBP were independently correlated with MMSE scores.
In elderly patients with hypertension, a decrease in SBP to 126 mmHg, compared with 134 mmHg, can delay cognitive impairment as well as reduce LIs and cerebral WMH lesions in patients with CSVD.
本研究旨在探讨强化血压控制对伴有脑小血管病（CSVD）的老年高血压患者认知功能的影响。
2020 年 5 月至 2022 年 6 月，选取北京石景山医院神经内科门诊及住院的 CSVD 合并高血压患者 140 例，随机分为标准血压控制组和强化血压控制组，调整降压药物剂量将血压降至目标水平。患者随访 2 年。分析和评估“入组”和“2 年随访”的病历或数据。采用简易精神状态检查量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知功能。头颅磁共振成像评估腔隙性梗死（LI）和脑白质高信号（WMH）。采用多元线性回归分析 MMSE 评分与血压、WMH 和 LI 的相关性。
（1）标准组 MMSE 和 MoCA 评分明显低于入组时，标准组 WMH 评分明显高于入组时。（2）随访 2 年后，两组 24 h 收缩压（SBP）、24 h 舒张压（DBP）、白天平均 SBP、白天平均 DBP、夜间平均 SBP 均显著下降，差异有统计学意义（P < 0.05）。（3）采用多元线性回归分析血压与 MMSE 评分的相关性。WMH 评分、LI、24 h SBP 和 24 h DBP 与 MMSE 评分独立相关。
与 134mmHg 相比，将老年高血压患者的收缩压降低至 126mmHg，可延迟认知功能障碍，并减少伴有 CSVD 的患者的 LI 和脑 WMH 病变。
