Guo Z, Fratiglioni L, Winblad B, Viitanen M
Stockholm Gerontology Research Center, Karolinska Institute, Sweden.
Am J Epidemiol. 1997 Jun 15;145(12):1106-13. doi: 10.1093/oxfordjournals.aje.a009073.
The authors examined the association of blood pressure with cognitive function as assessed by the Mini-Mental State Examination (MMSE) in a community-based Swedish cohort of 1,736 people aged 75-101 years. Age, sex, education, antihypertensive medication use, heart disease, and stroke were considered as covariates. Multiple linear regression analysis indicated that both systolic and diastolic blood pressure, measured in 1987-1989, were positively and significantly related to baseline MMSE score; baseline systolic pressure was also positively and significantly related to follow-up MMSE score, measured after an average period of 40.5 months among subjects who were not taking antihypertensive medication at baseline. Furthermore, in the nontreated group, multiple logistic regression showed that individuals with a baseline systolic pressure less than 130 mmHg had an odds ratio of 1.88 (p = 0.05) for follow-up cognitive impairment (MMSE score < 24) compared with those whose systolic pressure was 130-159 mmHg. An increased but not statistically significant risk of cognitive impairment was associated with high blood pressure (systolic pressure > or = 180 mmHg or diastolic pressure > or = 95 mmHg) only in persons taking antihypertensive medication at baseline. Subjects with systolic pressure of 160-179 mmHg tended to be at lower risk of cognitive impairment. These results may support the view that a certain blood pressure level, particularly a systolic pressure of at least 130 mmHg, is important to the maintenance of cognitive functioning in the very old. They also suggest that severe hypertension that is not well controlled (systolic pressure > or = 180 mmHg or diastolic pressure > or = 95 mmHg) is still a threat to cognitive function in this age group. However, the use of blood pressure measurements made at a single visit and the relatively short follow-up period should be considered when interpreting these results.
作者在瑞典一个以社区为基础的队列中，对1736名年龄在75至101岁之间的人群进行了研究，通过简易精神状态检查表（MMSE）评估血压与认知功能之间的关联。年龄、性别、教育程度、抗高血压药物使用情况、心脏病和中风被视为协变量。多元线性回归分析表明，1987 - 1989年测量的收缩压和舒张压均与基线MMSE评分呈显著正相关；基线收缩压也与随访MMSE评分呈显著正相关，随访MMSE评分是在基线时未服用抗高血压药物的受试者中平均40.5个月后测量的。此外，在未治疗组中，多元逻辑回归显示，与收缩压为130 - 159 mmHg的个体相比，基线收缩压低于130 mmHg的个体随访时发生认知障碍（MMSE评分 < 24）的比值比为1.88（p = 0.05）。仅在基线时服用抗高血压药物的人群中，高血压（收缩压≥180 mmHg或舒张压≥95 mmHg）与认知障碍风险增加相关，但无统计学意义。收缩压为160 - 179 mmHg的受试者认知障碍风险往往较低。这些结果可能支持这样一种观点，即一定的血压水平，特别是至少130 mmHg的收缩压，对于高龄人群认知功能的维持很重要。它们还表明，控制不佳的重度高血压（收缩压≥180 mmHg或舒张压≥95 mmHg）在这个年龄组中仍然是认知功能的一个威胁。然而，在解释这些结果时应考虑单次就诊时测量血压以及随访期相对较短的情况。
