Zhang Wenxin, Redline Susan, Viswanathan Anand, Ascher Simon B, Hari Darshana, Juraschek Stephen P, Tzourio Christophe, Drawz Paul E, Lipsitz Lewis A, Mittleman Murray A, Ma Yuan
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (W.Z., D.H., M.A.M., Y.M.).
Division of Sleep and Circadian Disorders (S.R.), Brigham and Women's Hospital, Boston, MA.
Hypertension. 2025 Apr;82(4):627-637. doi: 10.1161/HYPERTENSIONAHA.124.24222. Epub 2025 Jan 22.
Hypotensive episodes detected by 24-hour ambulatory blood pressure (BP) monitoring capture daily cumulative hypotensive stress and could be clinically relevant to cognitive impairment, but this relationship remains unclear.
We included participants from the Systolic Blood Pressure Intervention Trial (receiving intensive or standard BP treatment) who had 24-hour ambulatory BP monitoring measured near the 27-month visit and subsequent biannual cognitive assessments. We evaluated the associations of hypotensive episodes (defined as systolic BP drops of ≥20 mm Hg between 2 consecutive measurements that reached <100 mm Hg) and hypotensive duration (cumulative time of systolic BP <100 mm Hg) with subsequent cognitive function using adjusted linear mixed models. We further assessed 24-hour average BP and variability.
Among 842 participants with treated hypertension (mean age, 71±9 years; 29% women), the presence (versus absence) of recurrent hypotensive episodes (11%) was associated with lower digit symbol coding scores (difference in scores, -0.249 [95% CI, -0.380 to -0.119]) and their faster declines (difference in score changes, -0.128 [95% CI, -0.231 to -0.026]). A consistent dose-response association was also observed for longer hypotensive duration with worse Montreal Cognitive Assessment and digit symbol coding scores. The association with digit symbol coding scores remained significant after further adjusting for 24-hour average BP and variability and was not observed for hypotension defined by clinic, orthostatic, or 24-hour average BP. Intensive BP treatment increased 24-hour hypotensive episodes and modified its association with the decline in digit symbol coding score.
Twenty-four-hour hypotensive episodes were associated with worse cognitive function, especially in processing speed, and could be a novel marker for optimal BP control and dementia prevention.
通过24小时动态血压监测检测到的低血压发作记录了每日累积的低血压应激，可能与认知障碍在临床上相关，但这种关系仍不明确。
我们纳入了收缩压干预试验（接受强化或标准血压治疗）的参与者，这些参与者在27个月访视时进行了24小时动态血压监测，并随后进行了每半年一次的认知评估。我们使用调整后的线性混合模型评估低血压发作（定义为连续两次测量之间收缩压下降≥20 mmHg且收缩压<100 mmHg）和低血压持续时间（收缩压<100 mmHg的累积时间）与随后认知功能的关联。我们进一步评估了24小时平均血压和变异性。
在842例接受治疗的高血压患者中（平均年龄71±9岁；29%为女性），复发性低血压发作（11%）的存在（与不存在相比）与较低的数字符号编码得分相关（得分差异为-0.249 [95%CI，-0.380至-0.119]）及其更快下降（得分变化差异为-0.128 [95%CI，-0.231至-0.026]）。对于更长的低血压持续时间与更差的蒙特利尔认知评估和数字符号编码得分，也观察到了一致的剂量反应关联。在进一步调整24小时平均血压和变异性后，与数字符号编码得分的关联仍然显著，而对于诊所定义的低血压、直立性低血压或24小时平均血压定义的低血压则未观察到这种关联。强化血压治疗增加了24小时低血压发作，并改变了其与数字符号编码得分下降的关联。
24小时低血压发作与较差的认知功能相关，尤其是在处理速度方面，可能是最佳血压控制和痴呆预防的新标志物。
