The association between blood pressure and incident Alzheimer disease: a systematic review and meta-analysis.
The association between blood pressure and incident Alzheimer disease: a systematic review and meta-analysis.
复制标题
血压与阿尔茨海默氏病入射之间的关联：系统评价和荟萃分析。
DOI：
10.1097/ede.0b013e31822708b5
复制
发表时间：
2011-09
期刊：
影响因子：
--
通讯作者：
Blacker D
中科院分区：
文献类型：
--
作者：
Power MC;Weuve J;Gagne JJ;McQueen MB;Viswanathan A;Blacker D
许多流行病学研究已经考虑了血压（BP）和阿尔茨海默病之间的联系，但这种关系仍然知之甚少。在对AlzRisk在线数据库（www.alzrisk.org）进行研究的同时，我们进行了一项系统性综述，以确定所有符合预先规定标准的流行病学研究，这些研究报告了高血压、收缩压或舒张压与阿尔茨海默病事件之间的相关性。在可能的情况下，我们使用随机效应模型计算汇总指标，并探索BP评估时与年龄相关的潜在异质性。报告19个人群的18项研究符合合格标准。我们计算了三种血压指标的汇总相对危险度（RR =0.97 [95%置信区间= 0.80-1.16]）：高血压（RR =0.97 [95%置信区间= 0.80-1.16]）;收缩压升高10 mm Hg（RR =0.95 [0.91-1.00]）;舒张压升高10 mm Hg（RR =0.94 [0.85-1.04]）。我们无法计算收缩压或舒张压类别与阿尔茨海默病之间相关性的汇总估计值;然而，在各项研究中似乎没有一致的模式。在对血压评估时的年龄进行分层后，我们发现晚年高血压与阿尔茨海默病之间存在负相关，中年舒张期高血压与阿尔茨海默病之间存在不良相关。根据现有的流行病学研究，我们不能确定BP和阿尔茨海默病之间是否存在因果关系。选择偏差和反向因果关系可能解释了老年高血压与阿尔茨海默病之间的负相关性，但是，考虑到这些偏差的预期方向，它们不太可能解释中年高血压增加风险的建议。我们主张继续进行系统性综述;与本研究同时完成的关于该主题的Alzrisk数据库条目（www.alzrisk.org）将随着新研究的发表而更新。
Many epidemiologic studies have considered the association between blood pressure (BP) and Alzheimer disease, yet the relationship remains poorly understood. In parallel with work on the AlzRisk online database (www.alzrisk.org), we conducted a systematic review to identify all epidemiologic studies meeting pre-specified criteria reporting on the association between hypertension, systolic BP, or diastolic BP and incident Alzheimer disease. When possible, we computed summary measures using random-effects models and explored potential heterogeneity related to age at BP assessment. Eighteen studies reporting on 19 populations met the eligibility criteria. We computed summary relative risks (RRΣ) for three measures of BP: hypertension (RRΣ=0.97 [95% confidence interval= 0.80–1.16]); a 10 mm Hg-increase in systolic BP (RRΣ=0.95 [0.91–1.00]); and a 10 mm Hg-increase in diastolic BP (RRΣ=0.94 [0.85–1.04]). We were unable to compute summary estimates for the association between categories of systolic or diastolic BP and Alzheimer disease; however, there did not appear to be a consistent pattern across studies. After stratifying on age at BP assessment, we found a suggestion of an inverse association between late-life hypertension and Alzheimer disease and a suggestion of an adverse association between midlife diastolic hypertension and Alzheimer disease. Based on existing epidemiologic research, we cannot determine whether there is a causal association between BP and Alzheimer disease. Selection bias and reverse causation may account for the suggested inverse association between late-life hypertension on Alzheimer disease, but, given the expected direction of these biases, they are less likely to account for the suggestion that midlife hypertension increases risk. We advocate continuing systematic review; the Alzrisk database entry on this topic (www.alzrisk.org), which was completed in parallel with this work, will be updated as new studies are published.