Roles of Arterial Stiffness and Blood Pressure in Hypertension-Associated Cognitive Decline in Healthy Adults.
Roles of Arterial Stiffness and Blood Pressure in Hypertension-Associated Cognitive Decline in Healthy Adults.
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DOI：
10.1161/hypertensionaha.115.06277
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发表时间：
2016-01
期刊：
影响因子：
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通讯作者：
Quyyumi AA
中科院分区：
文献类型：
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作者：
Hajjar I;Goldstein FC;Martin GS;Quyyumi AA
尽管有强有力的证据表明高血压会导致认知能力下降，尤其是在执行领域，但血压与认知能力之间的关系一直是相互矛盾的。高血压的特征是血压升高和动脉僵硬度增加。我们的目的是调查动脉僵硬度在预测认知能力下降和解释高血压与执行能力下降之间的关联方面是否优于血压。随机选择的无症状人群（N = 591，年龄 = 49.2 岁，70% 女性，27% 黑人，教育程度 = 18 年）接受年度血管和认知评估。使用常用认知测试的计算机化版本来评估认知，并使用主成分分析来得出执行功能、记忆和工作记忆的认知分数。通过颈动脉-股动脉脉搏波速度（PWV）测量动脉僵硬度。在对人口统计、教育程度和基线认知表现进行调整后，较高的 PWV（而非血压）与执行力 (p=0.0002)、记忆力 (p=0.05) 和工作记忆力 (p=0.02) 得分的急剧下降相关。在调整高血压后，情况仍然如此。高血压与执行评分的较大下降相关（p=0.0029），合并高血压和 PWV 升高（>7 m/sec）的患者执行评分下降幅度最大（p 值高血压*PWV=0.02）。 PWV 解释了高血压与执行功能之间的关联（调整 PWV 后，高血压的 p 值=0.0029 vs 0.24）。在健康成年人中，在预测所有领域的认知能力下降以及解释高血压与执行功能的关联方面，动脉僵硬度的增加优于血压。动脉硬化，尤其是高血压患者的动脉硬化，可能是预防认知能力下降的一个目标。
Although there is strong evidence that hypertension leads to cognitive decline, especially in the executive domain, the relationship between blood pressure and cognition has been conflicted. Hypertension is characterized by blood pressure elevation and increased arterial stiffness. We aimed at investigating if arterial stiffness would be superior to blood pressure in predicting cognitive decline and explaining the hypertension-executive decline association. A randomly selected asymptomatic population (N=591, age=49.2 years, 70% women, 27% Black, education=18 years) underwent annual vascular and cognitive assessments. Cognition was assessed using computerized versions commonly used cognitive tests and principal component analysis was used for deriving cognitive scores for executive function, memory and working memory. Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWV). Higher PWV, but not blood pressure, was associated with a steeper decline in executive (p=0.0002), memory (p=0.05) and working memory (p=0.02) scores after adjusting for demographics, education, and baseline cognitive performance. This remained true after adjusting for hypertension. Hypertension was associated with greater decline in executive score (p=0.0029) and those with combined hypertension and elevated PWV (>7 m/sec) had the greatest decline in executive score (p-value hypertension*PWV=0.02). PWV explained the association between hypertension and executive function (p-value for hypertension=0.0029 vs 0.24 when adjusting for PWV). In healthy adults, increased arterial stiffness is superior to blood pressure in predicting cognitive decline in all domains and in explaining the hypertension-executive function association. Arterial stiffness, especially in hypertension, may be a target in the prevention of cognitive decline.