Skoog I, Andreasson L A, Landahl S, Lernfelt B
From the Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska University Hospital, the Department of Geriatric Medicine, Vasa Hospital, Göteborg University, Sweden.
Hypertension. 1998 Sep;32(3):404-9. doi: 10.1161/01.hyp.32.3.404.
In the general population, mean systolic and diastolic blood pressure increases up to age 75 years but decreases thereafter. The brain has a role in blood pressure regulation; it is not clear whether the cerebral changes that occur with aging contribute to the decline in blood pressure in the very elderly. We examined a population-based sample of 484 85-year-old persons (344 nondemented and 140 demented, 61 with Alzheimer's disease, 65 with vascular dementia, and 14 with other types of dementia) with a neuropsychiatric examination and blood pressure measurements. Dementia was diagnosed according to the criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders, edition 3, revised. Brain atrophy was measured by CT of the brain. In the nondemented group, frontal (r=-0.18, P=0.037) and parietal (r=-0.23, P=0.008) cortical atrophy and bifrontal ratio (r=-0.20, P=0.013) were associated with lower systolic blood pressure, and frontal (r=-0.23, P=0.010) and parietal (r=-0.24, P=0.008) cortical atrophy and bifrontal ratio (r=-0.23, P=0.006) with lower diastolic blood pressure. Systolic blood pressure was lower in subjects with Alzheimer's disease and vascular dementia, and diastolic blood pressure was lower in those with vascular dementia compared with the nondemented. Systolic (r=-0.27, P<0.0001) and diastolic (r=-0.10, P=0.020) blood pressure was negatively correlated to dementia severity. In the demented subjects, frontal cortical atrophy was correlated to lower diastolic blood pressure (r=-0.21, P=0.043). Our findings suggest that age-related changes in brain structure may contribute to the decrease in blood pressure in the very elderly and that low blood pressure in dementia disorders is mainly a secondary phenomenon.
在一般人群中，收缩压和舒张压的平均值在75岁之前会升高，但此后会下降。大脑在血压调节中发挥作用；目前尚不清楚随着年龄增长而发生的大脑变化是否会导致高龄老年人血压下降。我们对484名85岁老人进行了基于人群的抽样研究（344名非痴呆老人和140名痴呆老人，其中61名患有阿尔茨海默病，65名患有血管性痴呆，14名患有其他类型痴呆），进行了神经精神检查和血压测量。痴呆症根据《精神疾病诊断与统计手册》第3版修订本中提出的标准进行诊断。通过脑部CT测量脑萎缩。在非痴呆组中，额叶（r = -0.18，P = 0.037）和顶叶（r = -0.23，P = 0.008）皮质萎缩以及双侧额叶比值（r = -0.20，P = 0.013）与较低的收缩压相关，额叶（r = -0.23，P = 0.010）和顶叶（r = -0.24，P = 0.008）皮质萎缩以及双侧额叶比值（r = -0.23，P = 0.006）与较低的舒张压相关。与非痴呆老人相比，患有阿尔茨海默病和血管性痴呆的老人收缩压较低，患有血管性痴呆的老人舒张压较低。收缩压（r = -0.27，P < 0.0001）和舒张压（r = -0.10，P = 0.020）与痴呆严重程度呈负相关。在痴呆患者中，额叶皮质萎缩与较低的舒张压相关（r = -0.21，P = 0.043）。我们的研究结果表明，与年龄相关的大脑结构变化可能导致高龄老年人血压下降，并且痴呆症患者的低血压主要是一种继发现象。
