Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population
Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population
复制标题
一般日本老年人群的日常血压变化和痴呆风险
作者：
Emi Oishi;T. Ohara;S. Sakata;M. Fukuhara;J. Hata;Daigo Yoshida;Mao Shibata;T. Ohtsubo;T. Kitazono;Y. Kiyohara;T. Ninomiya
背景：几项观察性研究报道，较高的就诊血压变异性是认知障碍和痴呆的危险因素。然而，没有研究调查通过家庭血压测量评估的日常血压变异性与痴呆发展的关系。方法：对1674例≥60岁的日本社区无痴呆老年人（2007-2012）进行为期5年的随访。每天早晨在家测量血压3次，平均28天。每日收缩压（SBP）和舒张压变异性以家庭收缩压和舒张压变异系数（CoV）计算，分为四分位数。采用Cox比例风险模型计算家庭血压CoV水平与全因痴呆、血管性痴呆（VaD）和阿尔茨海默病（AD）发生的风险比及其95%置信区间。结果：随访期间，194名受试者发生全因痴呆；其中47人患有VaD， 134人患有AD。经年龄和性别调整的全因痴呆、VaD和AD的发病率随着家庭收缩压CoV水平的升高而显著增加（趋势均P <0.05）。在排除了潜在的混杂因素（包括家庭收缩压）后，这些关联保持不变。与家中SBP CoV水平第一四分位数的受试者相比，第四四分位数的受试者发生全因痴呆、VaD和AD的风险显著较高（全因痴呆的风险比=2.27,95%可信区间= 1.45-3.55，P<0.001； VaD的风险比=2.79,95%可信区间= 1.04-7.51，P=0.03； AD的风险比=2.22,95%可信区间= 1.31-3.75，P<0.001）。在冠状病毒水平与家庭舒张压之间也观察到类似的关联。同时，家庭收缩压水平与VaD的风险显著相关，但与全因痴呆和AD的风险无关。家中收缩压水平和家中收缩压的冠状病毒水平对痴呆各亚型的风险没有相互作用。结论：我们的研究结果表明，与家庭平均血压无关，每日血压变异性的增加是日本普通老年人发生全因痴呆、VaD和AD的一个重要危险因素。
Background: Several observational studies have reported that higher visit-to-visit blood pressure variability is a risk factor for cognitive impairment and dementia. However, no studies have investigated the association of day-to-day blood pressure variability assessed by home blood pressure measurement with the development of dementia. Methods: A total of 1674 community-dwelling Japanese elderly without dementia, ≥60 years of age, were followed up for 5 years (2007–2012). Home blood pressure was measured 3 times every morning for a median of 28 days. Day-to-day systolic (SBP) and diastolic blood pressure variabilities, calculated as coefficients of variation (CoV) of home SBP and diastolic blood pressure, were categorized into quartiles. The hazard ratios and their 95% confidence intervals of the CoV levels of home blood pressure on the development of all-cause dementia, vascular dementia (VaD), and Alzheimer disease (AD) were computed with a Cox proportional hazards model. Results: During the follow-up, 194 subjects developed all-cause dementia; of these, 47 had VaD and 134 had AD. The age- and sex-adjusted incidences of all-cause dementia, VaD, and AD increased significantly with increasing CoV levels of home SBP (all P for trend <0.05). These associations remained unchanged after adjustment for potential confounding factors, including home SBP. Compared with subjects in the first quartile of CoV levels of home SBP, the risks of the development of all-cause dementia, VaD, and AD were significantly higher in those in the fourth quartile (hazard ratio=2.27, 95% confidence interval=1.45–3.55, P<0.001 for all-cause dementia; hazard ratio=2.79, 95% confidence interval=1.04–7.51, P=0.03 for VaD; hazard ratio=2.22, 95% confidence interval=1.31–3.75, P<0.001 for AD). Similar associations were observed for CoV levels of home diastolic blood pressure. Meanwhile, home SBP levels were significantly associated with the risk of VaD but not with the risks of all-cause dementia and AD. There was no interaction between home SBP levels and CoV levels of home SBP on the risk of each subtype of dementia. Conclusions: Our findings suggest that increased day-to-day blood pressure variability is, independently of average home blood pressure, a significant risk factor for the development of all-cause dementia, VaD, and AD in the general elderly Japanese population.
影响因子：
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作者：
Brickman, Adam M.;Reitz, Christiane;Luchsinger, Jose A.;Manly, Jennifer J.;Schupf, Nicole;Muraskin, Jordan;DeCarli, Charles;Brown, Truman R.;Mayeux, Richard
通讯作者：
Mayeux, Richard