心房颤动患者的血压、脑损伤与认知衰退

Blood pressure, brain lesions and cognitive decline in patients with atrial fibrillation.

作者信息

Carmine Désirée, Aeschbacher Stefanie, Coslovsky Michael, Hennings Elisa, Paladini Rebecca E, Peter Raffaele, Burger Melanie, Reichlin Tobias, Rodondi Nicolas, Müller Andreas S, Ammann Peter, Conte Giulio, Auricchio Angelo, Moschovitis Giorgio, Bardoczi Julia B, Stauber Annina, De Perna Maria Luisa, Zuern Christine S, Sinnecker Tim, Badertscher Patrick, Sticherling Christian, Bonati Leo H, Conen David, Krisai Philipp, Osswald Stefan, Kühne Michael

机构信息

Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland.

Department of Cardiology/Electrophysiology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.

出版信息

Front Cardiovasc Med. 2024 Sep 3;11:1449506. doi: 10.3389/fcvm.2024.1449506. eCollection 2024.

DOI:10.3389/fcvm.2024.1449506

PMID:39314770

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11417621/

Abstract

BACKGROUND

The influence of atrial fibrillation (AF) and blood pressure (BP) on brain lesions and cognitive function is unclear. We aimed to investigate the association of BP with different types of brain lesions and cognitive decline in patients with AF.

METHODS

Overall, 1,213 AF patients underwent standardized brain magnetic resonance imaging at baseline and after 2 years, as well as yearly neurocognitive testing. BP was measured at baseline and categorized according to guidelines. New lesions were defined as new or enlarged brain lesions after 2 years. We defined cognitive decline using three different neurocognitive tests. Logistic and Cox regression analyses were performed to examine the associations of BP with new brain lesions and cognitive decline.

RESULTS

The mean age was 71 ± 8.4 years, 74% were male and mean BP was 135 ± 18/79 ± 12 mmHg. New ischemic lesions and white matter lesions were found in 5.4% and 18.4%, respectively. After multivariable adjustment, BP was not associated with the presence of new brain lesions after 2 years. There was no association between BP and cognitive decline over a median follow-up of 6 years when using the Montreal Cognitive Assessment or Digit Symbol Substitution Test. However, BP categories were inversely associated with cognitive decline using the Semantic Fluency Test, with the strongest association in patients with hypertension grade 1 [Hazard Ratio (95% Confidence Interval) 0.57(0.42 to 0.77)], compared to patients with optimal BP (p for linear trend: 0.025).

CONCLUSIONS

In a large cohort of AF patients, there was no association between BP and incidence of brain lesions after 2 years. Also, there was no consistent association between BP and cognitive decline over a follow-up of 6 years.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/study/NCT02105844, Identifier (NCT02105844).

摘要

背景

心房颤动（AF）和血压（BP）对脑损伤及认知功能的影响尚不清楚。我们旨在研究血压与房颤患者不同类型脑损伤及认知功能下降之间的关联。

方法

总共1213例房颤患者在基线期和2年后接受了标准化脑磁共振成像检查，以及每年一次的神经认知测试。在基线期测量血压并根据指南进行分类。新损伤定义为2年后出现的新的或扩大的脑损伤。我们使用三种不同的神经认知测试来定义认知功能下降。进行逻辑回归和Cox回归分析以检验血压与新脑损伤及认知功能下降之间的关联。

结果

平均年龄为71±8.4岁，74%为男性，平均血压为135±18/79±12mmHg。分别有5.4%和18.4%的患者出现了新的缺血性损伤和白质损伤。经过多变量调整后，血压与2年后新脑损伤的存在无关。在使用蒙特利尔认知评估或数字符号替换测试进行的中位随访6年期间，血压与认知功能下降之间没有关联。然而，使用语义流畅性测试时，血压分类与认知功能下降呈负相关，与最佳血压患者相比，1级高血压患者的关联最强[风险比（95%置信区间）0.57（0.42至0.77）]（线性趋势p值：0.025）。