Launer L J, Masaki K, Petrovitch H, Foley D, Havlik R J
National Institute for Public Health and the Environment, Erasmus University Medical School, Bilthoven, The Netherlands.
JAMA. 1995 Dec 20;274(23):1846-51.
To assess the long-term relationship of midlife blood pressure levels to late-life cognitive function.
The 4678 surviving cohort members of the prospective Honolulu Heart Program (baseline, 1965-1968) were examined a fourth time in 1991 through 1993 and given a cognitive test.
The subjects were 3735 Japanese-American men living in Hawaii in the community or in institutions, with an average age of 78 years at the fourth examination.
Cognitive function, measured by the 100-point Cognitive Abilities Screening Instrument (CASI), was categorized into good (reference: a CASI score of 92 to 100), intermediate (< 92 to 82), and poor (< 82). Midlife systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were measured in 1965, 1968, and 1971. A respondent was classified into the following categories if two of three measurements fell into the following groups: for SBP, < 110, 110 to 139, 140 to 159, and > or = 160 mm Hg; and for DBP, < 80, 80 to 89, 90 to 94, and > or = 95 mm Hg.
When we controlled for age and education, the risk for intermediate and poor cognitive function increased progressively with increasing level of midlife SBP category (P for trend < .03 and < .001, respectively). For every 10-mm Hg increase in SBP there was an increase in risk for intermediate cognitive function of 7% (95% confidence interval [CI], 3% to 11%) and for poor cognitive function of 9% (95% CI, 3% to 16%). Adjustment for prevalent stroke, coronary heart disease, and subclinical atherosclerosis reduced the strength of the relationship between midlife SBP and poor cognitive function to 5% (95% CI, 0% to 12%). The level of cognitive function was not associated with midlife DBP.
Midlife SBP is a significant predictor of reduced cognitive function in later life. Early control of SBP levels may reduce the risk for cognitive impairment in old age.
评估中年血压水平与晚年认知功能之间的长期关系。
对前瞻性檀香山心脏项目（基线时间为1965 - 1968年）中4678名存活队列成员于1991年至1993年进行了第四次检查，并进行了认知测试。
研究对象为3735名居住在夏威夷社区或养老院的日裔美国男性，第四次检查时平均年龄为78岁。
认知功能通过100分的认知能力筛查量表（CASI）进行测量，分为良好（参照：CASI评分为92至100）、中等（<92至82）和较差（<82）。1965年、1968年和1971年测量了中年收缩压（SBP）和舒张压（DBP）值。如果三次测量中有两次属于以下组，则将受试者分类如下：SBP方面，<110、110至139、140至159以及≥160 mmHg；DBP方面，<80、80至89、90至94以及≥95 mmHg。
在对年龄和教育程度进行控制后，中等和较差认知功能的风险随着中年SBP类别水平的升高而逐渐增加（趋势P值分别<0.03和<0.001）。SBP每升高10 mmHg，中等认知功能风险增加7%（95%置信区间[CI]，3%至11%），较差认知功能风险增加9%（95% CI，3%至16%）。对既往中风、冠心病和亚临床动脉粥样硬化进行校正后，中年SBP与较差认知功能之间的关系强度降至5%（95% CI，0%至12%）。认知功能水平与中年DBP无关。
中年SBP是晚年认知功能下降的重要预测因素。早期控制SBP水平可能降低老年认知障碍的风险。
