Associations of Nocturnal Blood Pressure With Cognition by Self-Identified Race in Middle-Aged and Older Adults: The GENOA (Genetic Epidemiology Network of Arteriopathy) Study.
Associations of Nocturnal Blood Pressure With Cognition by Self-Identified Race in Middle-Aged and Older Adults: The GENOA (Genetic Epidemiology Network of Arteriopathy) Study.
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DOI：
10.1161/jaha.117.007022
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发表时间：
2017-10-27
影响因子：
5.4
通讯作者：
Mosley TH
中科院分区：
文献类型：
--
作者：
Yano Y;Butler KR;Hall ME;Schwartz GL;Knopman DS;Lirette ST;Jones DW;Wilson JG;Hall JE;Correa A;Turner ST;Mosley TH
睡眠期间血压（夜间血压）与认知的关系是否因种族而异尚不清楚。 GENOA（动脉病遗传流行病学网络）研究的参与者在 2000 年至 2007 年间接受了动态血压测量、脑磁共振成像和认知功能测试（雷伊听觉言语学习测试、数字符号替换任务和轨迹制作测试 B 部分）。我们检查了夜间血压认知关联的多变量线性回归模型。在 755 名参与者中（平均年龄 63 岁；64% 为女性；42% 自认为是黑人；76% 正在服用抗高血压药物），夜间平均收缩压 (SBP)/舒张压为 126/69 毫米汞柱，白天收缩压/舒张压水平为 139/82 毫米汞柱，白天收缩压平均降低到晚上（下降）为 9%。在整个样本中，在数字符号替换任务和轨迹制作测试B部分中观察到种族交互作用（均P<0.15）。种族分层分析表明，在黑人而非白人中，夜间 SBP 水平增加 1-SD 与较差的数字符号替换任务和对数转换的轨迹制作测试 B 部分分数（非标准化回归系数 [95% 置信区间]：−1.98 [−3.28 至 −0.69] 和 0.06 [0.004–0.12]；两者 P<0.05）相关。通过脑磁共振成像测量的白质高信号量或脑萎缩的额外调整并没有改变结果。当夜间收缩压下降被评估为暴露时，结果相似，但白天收缩压水平与认知没有关联。夜间收缩压测量可能有助于评估中老年人（尤其是黑人）认知功能较低的潜在风险。
Whether the association of blood pressure (BP) during sleep (nocturnal BP) with cognition differs by race is unknown. Participants in the GENOA (Genetic Epidemiology Network of Arteriopathy) Study underwent ambulatory BP measurements, brain magnetic resonance imaging, and cognitive function testing (the Rey Auditory Verbal Learning Test, the Digit Symbol Substitution Task, and the Trail Making Test Part B) between 2000 and 2007. We examined multivariable linear regression models of the nocturnal BP‐cognition association. Among 755 participants (mean age, 63 years; 64% women; 42% self‐identified black race; 76% taking antihypertensive medication), mean nocturnal systolic BP (SBP)/diastolic BP was 126/69 mm Hg, daytime SBP/diastolic BP level was 139/82 mm Hg, and mean reduction in SBP from day to night (dipping) was 9%. Among the entire sample, a race interaction was observed in Digit Symbol Substitution Task and Trail Making Test Part B (both P<0.15). Race‐stratified analyses showed that a 1‐SD increase in nocturnal SBP levels was associated with poorer Digit Symbol Substitution Task and log‐transformed Trail Making Test Part B scores (unstandardized regression coefficient [95% confidence interval]: −1.98 [−3.28 to −0.69] and 0.06 [0.004–0.12]; both P<0.05) in black but not white individuals. Additional adjustments for white matter hyperintensity volumes or brain atrophy, measured via brain magnetic resonance imaging, did not change the results. Results were similar when nocturnal SBP dipping was assessed as the exposure, yet daytime SBP levels yielded no association with cognition. Nocturnal SBP measurements may be useful in assessing the potential risk for lower cognitive function in middle‐aged and older adults, particularly in black individuals.