Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study.
Hypertension, white matter hyperintensities, and concurrent impairments in mobility, cognition, and mood: the Cardiovascular Health Study.
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DOI：
10.1161/circulationaha.110.978114
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发表时间：
2011-03-01
期刊：
影响因子：
37.8
通讯作者：
Lipsitz LA
中科院分区：
文献类型：
--
作者：
Hajjar I;Quach L;Yang F;Chaves PH;Newman AB;Mukamal K;Longstreth W Jr;Inzitari M;Lipsitz LA
我们的目的是调查高血压和并发的运动、认知和情绪障碍之间的关系;脑白色物质高信号在介导这种关系中的作用;以及这些障碍对老年高血压患者残疾和死亡率的影响。每年（1992-1999年）对心血管健康研究中的4700名参与者（年龄：74.7岁，58%为女性，17%为非洲裔美国人，68%为高血压，3600人在1992-93年接受了脑MRI，1992-2005年的生存数据）进行血压，步态速度，数字符号替代测试和流行病学研究中心抑郁量表测量。使用基线潜伏特征分析，我们发现498例（11%）受试者有并发损伤，3086例（66%）在所有三项指标上均完好无损。1992年至1999年期间，651人（21%）在所有三个领域都受到损害。高血压患者更可能在基线时受损（比值比1.23，95% CI（1.04-1.42），p=0.01），并在随访期间受损（风险比（HR）= 1.3，95%置信区间（CI）：1.02至1.66，p=0.037）。更大程度的白色高信号与3个领域的损伤相关（p=0.007），并介导与高血压的相关性（在模型中校正白色高信号后，高血压的p=0.19，HR变化21%）。这三个领域的损害增加了高血压的后续残疾（p<0.0001）。高血压死亡率在受损者中也增加（与未受损的高血压个体相比，HR=1.10，95% CI（1.04-1.17），p=0.004）。高血压增加了活动能力、认知和情绪同时受损的风险，从而增加残疾和死亡率。这种关联部分是由微血管脑损伤介导的。
Our objective was to investigate the association between hypertension and concurrent impairments in mobility, cognition and mood; the role of brain white matter hyperintensities in mediating this association; and the impact of these impairments on disability and mortality in elderly hypertensive individuals. Blood pressure, gait speed, digit symbol substitution test, and the Center for Epidemiologic Studies Depression Scale were measured yearly (1992-1999) on 4700 participants in the Cardiovascular Health Study (age: 74.7, 58% women, 17% African Americans, 68% hypertension, 3600 had brain MRI in 1992-93, survival data 1992-2005). Using latent profile analysis at baseline, we found that 498 (11%) subjects had concurrent impairments and 3086 (66%) were intact on all three measures. Between 1992 and 1999, 651 (21%) became impaired in all three domains. Hypertensive individuals were more likely to be impaired at baseline (Odds ratio 1.23, 95% CI (1.04-1.42), p=0.01) and become impaired during the follow-up (Hazard Ratio (HR)= 1.3, 95% Confidence Interval (CI): 1.02 to 1.66, p=0.037). Greater degree of white matter hyperintensities was associated with impairments in the 3 domains (p=0.007) and mediated the association with hypertension (p=0.19 for hypertension after adjusting for white matter hyperintensities in the model, 21% HR change). Impairments in the three domains increased subsequent disability with hypertension (p<0.0001). Hypertension mortality also was increased in those impaired (compared to unimpaired hypertensive individuals HR=1.10, 95% CI (1.04-1.17), p=0.004). Hypertension increases the risk of concurrent impairments in mobility, cognition and mood, which increases disability and mortality. This association is partly mediated by microvascular brain injury.