School of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Diabetes. 2024 Oct;16(10):e70020. doi: 10.1111/1753-0407.70020.
We aimed to explore the association between visit-to-visit systolic blood pressure variability (BPV) and cognitive function in individuals with type 2 diabetes.
We performed a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) substudy. A total of 2867 diabetes patients with ≥3 BP measurements between the 4- and 20-month visits were included. Visit-to-visit systolic BPV was calculated. Cognitive decline was defined as a Mini-Mental State Exam (MMSE), Digit Symbol Substitution Test (DSST), or Rey Auditory Verbal Learning Test (RAVLT) score greater than 1 standard deviation (SD) below the baseline mean, or a Stroop test score more than 1 SD above the baseline mean. The associations of systolic BPV with risks of cognitive decline were examined using Cox proportional hazards models, and with changes in brain magnetic resonance imaging parameters were evaluated using mixed models.
The risk of cognitive decline defined by the DSST score (but not by other scores) increased significantly with systolic BPV quartiles (p for trend = 0.008), and there was a 55% increased risk for BPV quartile 4 versus quartile 1 (hazard ratio = 1.55, 95% confidence interval 1.10-2.19). Furthermore, a positive correlation was observed between systolic BPV and change in white matter lesion volume (β = 0.07, 95% CI 0.01-0.13).
A greater visit-to-visit systolic BPV was significantly associated with an increased risk of cognitive decline measured by DSST and an increase in white matter lesion volume in patients with type 2 diabetes.
我们旨在探讨 2 型糖尿病患者中收缩压变异性（BPV）与认知功能之间的关系。
我们对心血管风险行动控制糖尿病患者认知下降（ACCORD-MIND）亚研究进行了事后分析。共纳入 2867 例在 4-20 个月访视期间有≥3 次血压测量的糖尿病患者。计算收缩压变异性。认知衰退定义为简易精神状态检查（MMSE）、数字符号替代测试（DSST）或 Rey 听觉言语学习测试（RAVLT）评分较基线平均值低 1 个标准差（SD）以上，或斯特鲁普测试评分较基线平均值高 1 个 SD 以上。使用 Cox 比例风险模型检查收缩压变异性与认知衰退风险的相关性，并使用混合模型评估脑磁共振成像参数的变化。
DSST 评分定义的认知衰退风险（但其他评分则没有）与收缩压四分位值呈显著正相关（趋势检验 P=0.008），与四分位值 1 相比，四分位值 4 的风险增加了 55%（风险比 1.55，95%置信区间 1.10-2.19）。此外，收缩压变异性与白质病变体积变化呈正相关（β=0.07，95%置信区间 0.01-0.13）。
收缩压变异性越大，2 型糖尿病患者的认知衰退风险（以 DSST 衡量）和白质病变体积增加的风险也越高。
