[老年单纯收缩期高血压与认知功能。 Syst-Eur研究经验]

[Isolated systolic hypertension and cognitive function in the aged. Experience of the Syst-Eur study].

作者信息

Seux M L, Thijs L, Forette F

机构信息

Service de gérontologie, hôpital Broca (CHU Cochin, université Paris V).

出版信息

Arch Mal Coeur Vaiss. 1997 Aug;90(8):1169-72.

DOI:

PMID:9404430

Abstract

OBJECTIVE

To determinate cognitive status and its correlates in older patients with isolated systolic hypertension.

METHODS

Syst-Eur is a double-blind placebo-controlled outcome trial conducted in European patients over 60 years of age with isolated systolic hypertension. Moreover, a side-project--the Vascular Dementia Project--is designed to assess cognitive functions and to follow-up their evolution to determine the influence of antihypertensive therapy on vascular dementia incidence. Cognitive functions were evaluated at entry with the MiniMental State Examination (MMSE) in 2250 patients included in Syst-Eur. Cognitive impairment was defined with a MMSE score < or = 23 and led to further evaluation. Baseline blood pressure (BP) was based on the average of six sitting blood pressure readings at three run-in visits 1 month apart. Statistical analysis used Spearman correlation.

RESULTS

The MMSE was analysed in 1374 women and 751 men whose mean age was 70 years (range: 60-100). The median level of education expressed as the age at which they stopped their education at school, was 15 years. Baseline blood pressure averaged 173 +/- 10/86 +/- 6 mmHg. Before randomisation in the trial, 899 (40%) patients had received antihypertensive therapy and 602 (27%) had experienced cardiovascular complications. The MMSE-scores ranged from 15 to 30 (median = 29). The maximal score of 30 was reached by 609 (30%) subjects. Among the 59 (3%) patients with a MMSE-score of 23 or less, 5 were considered to be demented according to the DSM IIIR criteria. The MMSE-scores decreased with advancing age in men (r = -0.16; p < 0.001) and women alike (r = -0.24; p < 0.001). In both men and women, they were positively correlated with the level of education (r = 0.30 and 0.32, respectively; p < 0.001). They were negatively correlated with systolic blood pressure (r = 0.10; p < 0.001) and slightly positively correlated with diastolic blood pressure (r = 0.05; p = 0.03). Previously treated patients or patients reporting cardiovascular complications at baseline had lower MMSE-scores than their non-treated counterparts or subjects without cardiovascular complications (median = 28 and 29, respectively, p < 0.003).

CONCLUSION

In a European cohort of 2225 patients over 60 years of age with isolated systolic hypertension, the level of cognitive functions evaluated with the MMSE decreases with advancing age or lesser educational level. It also decreases with higher systolic blood pressure or lower diastolic blood pressure. The influence of antihypertensive therapy on cognitive status will be prospectively evaluated in Syst-Eur Vascular Dementia Project.

摘要

目的

确定老年单纯收缩期高血压患者的认知状态及其相关因素。

方法

Syst-Eur试验是一项双盲安慰剂对照结局试验，在60岁以上的欧洲单纯收缩期高血压患者中进行。此外，一个附带项目——血管性痴呆项目——旨在评估认知功能并跟踪其演变，以确定抗高血压治疗对血管性痴呆发病率的影响。在Syst-Eur试验纳入的2250例患者中，入组时用简易精神状态检查表（MMSE）评估认知功能。认知障碍定义为MMSE评分≤23分，并进行进一步评估。基线血压基于在相隔1个月的3次导入期访视中6次坐位血压读数的平均值。采用Spearman相关性进行统计分析。

结果

对1374例女性和751例男性进行了MMSE分析，他们的平均年龄为70岁（范围：60-100岁）。以停止上学年龄表示的教育年限中位数为15年。基线血压平均为173±10/86±6 mmHg。在试验随机分组前，899例（40%）患者接受过抗高血压治疗，602例（27%）有心血管并发症。MMSE评分范围为15至30分（中位数=29分）。609例（30%）受试者达到了30分的最高分。在MMSE评分为23分及以下的59例（3%）患者中，根据DSM IIIR标准，5例被认为患有痴呆症。男性（r=-0.16；p<0.0０1）和女性（r=-0.24；p<0.0０1）的MMSE评分均随年龄增长而降低。在男性和女性中，MMSE评分均与教育水平呈正相关（分别为r=0.30和0.32；p<0.0０1）。与收缩压呈负相关（r=0.10；p<0.0０1），与舒张压呈轻度正相关（r=0.05；p=0.03）。基线时接受过治疗的患者或报告有心血管并发症的患者，其MMSE评分低于未治疗的患者或无心血管并发症的患者（中位数分别为28分和29分，p<0.003）。