Skoog I, Lernfelt B, Landahl S, Palmertz B, Andreasson L A, Nilsson L, Persson G, Odén A, Svanborg A
Department of Clinical Neurosciences, Sahlgrenska Hospital, Gothenburg, Sweden.
Lancet. 1996 Apr 27;347(9009):1141-5. doi: 10.1016/s0140-6736(96)90608-x.
Vascular causes of dementia may be more common than supposed. Vascular factors may also have a role in late-onset Alzheimer's disease, but the role of hypertension in the development of dementia is unclear.
As part of the Longitudinal Population Study of 70-year-olds in Göteborg, Sweden, we analysed the relation between blood pressure and the development of dementia in the age intervals 70-75, 75-79, and 79-85 years in those non-demented at age 70 (n = 382). The sample was followed up for 15 years and examined repeatedly with a comprehensive investigation, including a psychiatric and physical examination. a
Participants who developed dementia at age 79-85 had higher systolic blood pressure at age 70 (mean 178 vs 164 mm Hg, p = 0.034) and higher diastolic blood pressure at ages 70 (101 vs 92, p = 0.004) and 75 (97 vs 90, p = 0.022) than those who did not develop dementia. For subtypes of dementia, higher diastolic blood pressure was recorded at age 70 (101, p = 0.019) for those developing Alzheimer's disease and at age 75 (101, p = 0.015) for those developing vascular dementia than for those who did not develop dementia. Participants with white-matter lesions on computed tomography at age 85 had higher blood pressure at age 70 than those without such lesions. Blood pressure declined in the years before dementia onset and was then similar to or lower than that in non-demented individuals.
Previously increased blood pressure may increase the risk for dementia by inducing small-vessel disease and white-matter lesions. To what extent the decline in blood pressure before dementia onset is a consequence or a cause of the brain disease remains to be elucidated.
血管性痴呆的病因可能比想象的更为常见。血管因素在晚发型阿尔茨海默病中可能也起作用，但高血压在痴呆症发展中的作用尚不清楚。
作为瑞典哥德堡70岁人群纵向队列研究的一部分，我们分析了70岁时无痴呆症的人群（n = 382）在70 - 75岁、75 - 79岁和79 - 85岁年龄区间血压与痴呆症发生之间的关系。该样本随访了15年，并通过包括精神和体格检查在内的全面调查进行反复检查。
在79 - 85岁时发生痴呆症的参与者在70岁时收缩压更高（平均178 vs 164 mmHg，p = 0.034），在70岁（101 vs 92，p = 0.004）和75岁（97 vs 90，p = 0.022）时舒张压也更高，高于未发生痴呆症的参与者。对于痴呆症亚型，发生阿尔茨海默病的参与者在70岁时舒张压更高（101，p = 0.019），发生血管性痴呆的参与者在75岁时舒张压更高（101，p = 0.015），高于未发生痴呆症的参与者。85岁时计算机断层扫描显示有白质病变的参与者在70岁时血压高于无此类病变的参与者。血压在痴呆症发病前几年下降，然后与非痴呆个体相似或更低。
先前血压升高可能通过引发小血管疾病和白质病变增加痴呆症风险。痴呆症发病前血压下降在多大程度上是脑部疾病的结果或原因仍有待阐明。
