Kilander L, Nyman H, Boberg M, Hansson L, Lithell H
Hypertension. 1998 Mar;31(3):780-6. doi: 10.1161/01.hyp.31.3.780.
Recent findings of a linkage between high blood pressure (BP) and later development of dementia have given new prospects on cerebral target-organ damage in hypertension and have added substance to the concept of "preventable senility." The aim of this study was to analyze the impact of hypertension, circadian BP profile, and disturbed glucose metabolism on cognitive function. The study population consisted of 999 seventy-year-old men from a population-based cohort study in Uppsala, Sweden, followed with respect to cardiovascular risk factors since the age of 50 years. At the age of 70, 24-hour ambulatory BP was monitored together with measurements of insulin sensitivity, glucose tolerance, serum lipids, and lipoproteins. Cognitive function was assessed by the Mini-Mental State Examination and the Trail-Making Test. High diastolic BP at baseline predicted later impaired cognitive performance, even after excluding men with a previous stroke (n = 70). Cross-sectional measurements at age 70 showed that high 24-hour BP, nondipping, insulin resistance, and diabetes all were related to low cognitive function. The relationships between hypertension and cognitive impairment were strongest in untreated men. These data from a general population of healthy elderly men indicate that hypertension and associated metabolic disturbances might be susceptibility factors for cognitive disorders. The findings add support to possibilities of intervention in early stages in cognitive decline, ie, before manifest dementia.
近期关于高血压（BP）与痴呆症后期发展之间存在联系的研究结果，为高血压患者的脑靶器官损害带来了新的前景，并充实了“可预防的衰老”这一概念。本研究的目的是分析高血压、昼夜血压模式以及糖代谢紊乱对认知功能的影响。研究人群包括来自瑞典乌普萨拉一项基于人群的队列研究中的999名70岁男性，自50岁起就对他们的心血管危险因素进行跟踪。在70岁时，对他们进行24小时动态血压监测，并测量胰岛素敏感性、葡萄糖耐量、血脂和脂蛋白。通过简易精神状态检查表和连线测验评估认知功能。即使排除了既往有中风史的男性（n = 70），基线时的高舒张压仍可预测后期认知功能受损。70岁时的横断面测量结果显示，24小时血压升高、非勺型血压、胰岛素抵抗和糖尿病均与低认知功能有关。高血压与认知障碍之间的关系在未接受治疗的男性中最为明显。这些来自健康老年男性普通人群的数据表明，高血压及相关代谢紊乱可能是认知障碍的易感因素。这些发现为在认知功能下降的早期阶段（即显性痴呆出现之前）进行干预提供了支持。
