Lennon Matthew J, Van Dalen Jan Willem, Lo Jessica W, Thalamuthu Anbupalam, Crawford John D, Schutte Aletta E, Sachdev Perminder S
Centre For Healthy Brain Aging (CHeBA), Discipline of Psychiatry and Mental Health, Level 1, AGSM (G27), University of New South Wales, Kensington, New South Wales, Australia.
Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales, Australia.
J Clin Hypertens (Greenwich). 2025 Aug;27(8):e70129. doi: 10.1111/jch.70129.
High blood pressure (BP) is a risk factor for cognitive decline. Increasingly, studies have found the relationship to be nonlinear, with low BP also indicating higher risk. This UK Biobank study examines the nonlinear relationships between BP and cognitive function, including whether the relationships differ by cognitive domain. Systolic (SBP) and diastolic BP (DBP) were measured at baseline. Cognitive domains included fluid intelligence, attention, and reaction time, measured at baseline and over time. Nonlinear mixed-effects regression models, including natural spline terms for SBP and DBP, were used to assess the relationships. Additional models evaluated interactions with age, sex, and hypertension history/antihypertensive use. There were 439 301 (mean age = 56.3, SD = 8.1, 45.1% male) included participants. Baseline SBP had significant inverted U-shaped relationships with fluid intelligence (p < 0.0001), attention (p < 0.0001), and reaction time (p < 0.0001), with substantially different ideal SBPs for each domain (118, 127.5, and 150.5 mmHg, respectively). Baseline DBP had significant relationships with fluid intelligence (p < 0.0001) and attention (p < 0.0001), again with varying ideal DBPs (57.5 and 74.5 mmHg, respectively). Higher baseline SBP had a small, inverse relation with trajectories of attention during the study (p < 0.0001), but no relationship with trajectories of either fluid intelligence or reaction time. Older, male, and untreated hypertension subgroups had significantly poorer reaction time at lower baseline SBP and DBP (p < 0.0001). The relationship between BP and cognitive function is nonlinear with the three domains optimal at differing BP levels. Older persons, males, or hypertensive patients may be particularly susceptible to negative cognitive effects of low BP.
高血压是认知能力下降的一个风险因素。越来越多的研究发现这种关系是非线性的，低血压也表明风险更高。这项英国生物银行研究考察了血压与认知功能之间的非线性关系，包括这些关系在不同认知领域是否存在差异。在基线时测量收缩压（SBP）和舒张压（DBP）。认知领域包括流体智力、注意力和反应时间，在基线时及随访期间进行测量。使用非线性混合效应回归模型，包括SBP和DBP的自然样条项，来评估这些关系。其他模型评估了与年龄、性别以及高血压病史/抗高血压药物使用情况的相互作用。共有439301名参与者（平均年龄 = 56.3岁，标准差 = 8.1岁，45.1%为男性）。基线SBP与流体智力（p < 0.0001）、注意力（p < 0.0001）和反应时间（p < 0.0001）呈显著的倒U形关系，每个领域的理想SBP有很大差异（分别为118、127.5和150.5 mmHg）。基线DBP与流体智力（p < 0.0001）和注意力（p < 0.0001）呈显著关系，理想DBP也各不相同（分别为57.5和74.5 mmHg）。较高的基线SBP与研究期间注意力轨迹呈小的负相关（p < 0.0001），但与流体智力或反应时间轨迹无相关性。年龄较大、男性以及未治疗的高血压亚组在较低的基线SBP和DBP水平下反应时间明显更差（p < 0.0001）。血压与认知功能之间的关系是非线性的，在不同血压水平下三个领域各有最佳值。老年人、男性或高血压患者可能特别容易受到低血压对认知的负面影响。
