A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly.
A U-shaped Association Between Blood Pressure and Cognitive Impairment in Chinese Elderly.
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DOI：
10.1016/j.jamda.2016.11.011
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发表时间：
2017-02-01
影响因子：
7.6
通讯作者：
Shi XM
中科院分区：
文献类型：
--
作者：
Lv YB;Zhu PF;Yin ZX;Kraus VB;Threapleton D;Chei CL;Brasher MS;Zhang J;Qian HZ;Mao C;Matchar DB;Luo JS;Zeng Y;Shi XM
高血压或低血压可能与认知功能障碍有关，而老年人血压与认知功能障碍之间的关系尚未得到充分研究。这项研究的目的是确定血压是否与老年人的认知功能障碍有关，如果是的话，准确地描述这种联系。2011年中国健康长寿纵向调查（CLHLS）第六轮调查的横断面数据，以中国长寿地区的社区为基础，7,144名65岁及以上的中国老年人被纳入样本，测量了收缩压（SBP）和舒张压（DBP），脉压（PP）计算为（SBP）-（DBP），平均动脉压（MAP）计算为1/3（SBP）+ 2/3（DBP）。认知功能通过经验证的简易精神状态检查（MMSE）进行评估。基于广义加性模型（GAMs）的结果，认知功能障碍与SBP、DBP、PP和MAP之间存在U型关联。通过二次模型确定认知功能障碍（MMSE<24）风险最小化的临界点分别为141 mmHg、85 mmHg、62 mmHg和103 mmHg。在logistic模型中，SBP、DBP和MAP保持U型相关，但PP不存在。低于确定的临界点，血压每降低1 mmHg，分别对应认知障碍风险增加0.7%、1.1%和1.1%。在临界点以上，血压每升高1 mmHg，SBP、DBP和MAP的认知功能损害风险分别增加1.2%、1.8%和2.1%。在中国老年人群中发现血压与认知功能呈U型关系，识别这些情况对于识别认知功能障碍的高危人群和个体化血压管理以预防认知功能障碍具有重要意义。
Higher or lower blood pressure may relate to cognitive impairment, while the relationship between blood pressure and cognitive impairment among the elderly is not well-studied. The study objective was to determine whether blood pressure is associated with cognitive impairment in the elderly, and, if so, to accurately describe the association. Cross-sectional data from the sixth wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2011 Community-based setting in longevity areas in China 7,144 Chinese elderly aged 65 years and older were included in the sample Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured, pulse pressure (PP) was calculated as (SBP)-(DBP) and mean arterial pressures (MAP) was calculated as 1/3(SBP) + 2/3(DBP). Cognitive function was assessed via a validated Mini-Mental State Examination (MMSE). Based on the results of generalized additive models (GAMs), U-shaped associations were identified between cognitive impairment and SBP, DBP, PP and MAP. The cut-points at which risk for cognitive impairment (MMSE<24) was minimized were determined by quadratic models as 141 mmHg, 85 mmHg, 62 mmHg and 103 mmHg, respectively. In the logistic models, U-shaped associations remained for SBP, DBP, and MAP but not PP. Below the identified cut-points, each 1mmHg decrease in blood pressure corresponded to 0.7%, 1.1%, and 1.1% greater risk in the risk of cognitive impairment, respectively. Above the cut-points, each 1mmHg increase in blood pressure corresponded to 1.2%, 1.8%, and 2.1% greater risk of cognitive impairment for SBP, DBP and MAP, respectively. A U-shaped association between blood pressure and cognitive function in an elderly Chinese population was found. Recognition of these instances is important identifying the high-risk population for cognitive impairment and to individualize blood pressure management for cognitive impairment prevention.