脉搏波速度测量的动脉僵硬度与高血压个体认知能力下降相关：系统评价。

Arterial stiffness measured by pulse wave velocity correlated with cognitive decline in hypertensive individuals: a systematic review.

机构信息

Department: University of Miami Miller School of Medicine, Evelyn F. McKnight Brain Institute, 1120 NW 14th St, Miami, Fl, 33136, USA.

出版信息

BMC Neurol. 2024 Oct 16;24(1):393. doi: 10.1186/s12883-024-03905-8.

DOI:10.1186/s12883-024-03905-8

PMID:39415095

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11481605/

Abstract

BACKGROUND

Arterial stiffness is a degenerative modification in the arterial wall that significantly affects normal aging. Arterial hypertension is a major risk factor for cerebrovascular impairment. Pulse wave velocity (PWV) is an established gold standard for measuring arterial stiffness. Studies demonstrated that individuals with elevated blood pressure (BP) and PWV are more likely to experience worse cognitive decline compared to those with either condition alone. The aim of this review is to explore the clinical importance of arterial stiffness for cognitive function in older adults with hypertension.

METHODS

The systematic review was reported following the PRISMA 2020 guidelines and Cochrane protocol and was registered in NIHR PROSPERO. PubMed, Embase, Web of Science, CINAHL, and Cochrane databases were searched for relevant publications up to December 2022. Articles were filtered by age and type of study and only those including a sample size of at least 500 individuals were selected. Screening of abstracts and full-text review of selected articles were carried out through Covidence.

RESULTS

The full-text review included a total of 434 articles. Twenty-eight prospective studies have met the inclusion criteria. Selected studies used PWV as the main measurement of stiffness: 24 used carotid-femoral, 2 used brachial-ankle, 1 used aortic PWV, and 11 compared different measures. Studies demonstrated a strong association between increased BP and PWV with brain damage and cognitive deterioration among older adults. One study did not find an interaction with hypertension, while another study found that PWV but not BP was associated with cognitive decline. Few studies showed that the association between stiffness and cognitive outcomes was not significant after adjustment for BP. Several authors suggested that cognitive decline induced by stiff vasculature and hypertension benefited from antihypertensive therapy.

CONCLUSION

The results of this review demonstrated that arterial hypertension is an important factor linking arterial stiffness to cognitive health in older individuals. BP plays a crucial role in brain integrity, whereas PWV was shown to be a strong measure associated with cognitive decline. Together, they can lead to disabling cognitive outcomes. Early screening of stiffness, BP control, and compliance with treatment are essential for cerebrovascular disease prevention.

TRIAL REGISTRATION

NIHR PROSPERO registry ID: CRD42022379887 .

摘要

背景

动脉僵硬度是动脉壁的退行性改变，显著影响正常衰老。动脉高血压是脑血管损伤的主要危险因素。脉搏波速度（PWV）是测量动脉僵硬度的既定金标准。研究表明，与仅存在高血压或 PWV 一种情况的个体相比，血压（BP）和 PWV 升高的个体更有可能经历认知能力下降。本综述的目的是探讨高血压老年患者动脉僵硬度对认知功能的临床重要性。

方法

该系统评价按照 PRISMA 2020 指南和 Cochrane 方案进行，并在 NIHR PROSPERO 注册。对截至 2022 年 12 月的 PubMed、Embase、Web of Science、CINAHL 和 Cochrane 数据库进行了相关文献检索。通过 Covidence 筛选摘要和选定文章的全文审查。

结果

全文审查共包括 434 篇文章。28 项前瞻性研究符合纳入标准。选定的研究使用 PWV 作为僵硬度的主要测量指标：24 项研究使用颈-股 PWV，2 项研究使用臂-踝 PWV，1 项研究使用主动脉 PWV，11 项研究比较了不同的测量方法。研究表明，在老年人中，BP 和 PWV 的增加与脑损伤和认知恶化之间存在很强的相关性。一项研究没有发现高血压的交互作用，另一项研究发现 PWV 而不是 BP 与认知能力下降有关。少数研究表明，在调整 BP 后，僵硬度与认知结果之间的关联不显著。一些作者认为，由僵硬的血管和高血压引起的认知能力下降受益于降压治疗。