Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study.
Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study.
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DOI：
10.1161/circulationaha.116.025667
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发表时间：
2017-08-08
期刊：
影响因子：
37.8
通讯作者：
Ninomiya T
中科院分区：
文献类型：
--
作者：
Oishi E;Ohara T;Sakata S;Fukuhara M;Hata J;Yoshida D;Shibata M;Ohtsubo T;Kitazono T;Kiyohara Y;Ninomiya T
补充数字内容可在文本中找到。几项观察性研究报告说，较高的访视间血压变异性是认知障碍和痴呆的危险因素。然而，还没有研究调查家庭血压测量评估的日常血压变异性与痴呆症发展的关系。对1674名年龄≥60岁的无痴呆症的日本社区居住老年人进行了为期5年的随访（2007-2012年）。每天早晨测量3次家庭血压，中位数为28天。每日收缩压（SBP）和舒张压变异性，计算为家庭SBP和舒张压的变异系数（CoV），分为四分位数。采用考克斯比例风险模型计算家庭血压CoV水平对全因痴呆、血管性痴呆（VaD）和阿尔茨海默病（AD）发展的风险比及其95%置信区间。在随访期间，194名受试者发展为全因痴呆;其中47名患有VaD，134名患有AD。年龄和性别校正的全因痴呆、VaD和AD的发病率随着家庭SBP的CoV水平的增加而显著增加（所有趋势P <0.05）。在调整潜在混杂因素（包括家庭SBP）后，这些相关性保持不变。与家庭SBP CoV水平第一个四分位数的受试者相比，第四个四分位数的受试者发生全因痴呆、VaD和AD的风险显著更高（全因痴呆的危险比=2.27，95%可信区间=1.45-3.55，P<0.001;风险比=2.79，95%置信区间=1.04-7.51，P=0.03（VaD）;风险比=2.22，95%置信区间=1.31-3.75，P<0.001（AD））。家庭舒张压的CoV水平也观察到类似的相关性。同时，家庭SBP水平与VaD的风险显著相关，但与全因痴呆和AD的风险无关。家庭收缩压水平和家庭收缩压的CoV水平对各亚型痴呆的风险无相互作用。我们的研究结果表明，增加的日常血压变异性是独立于平均家庭血压，一个重要的危险因素的发展全因痴呆症，VaD和AD在一般老年日本人口。
Supplemental Digital Content is available in the text. Several observational studies have reported that higher visit-to-visit blood pressure variability is a risk factor for cognitive impairment and dementia. However, no studies have investigated the association of day-to-day blood pressure variability assessed by home blood pressure measurement with the development of dementia. A total of 1674 community-dwelling Japanese elderly without dementia, ≥60 years of age, were followed up for 5 years (2007–2012). Home blood pressure was measured 3 times every morning for a median of 28 days. Day-to-day systolic (SBP) and diastolic blood pressure variabilities, calculated as coefficients of variation (CoV) of home SBP and diastolic blood pressure, were categorized into quartiles. The hazard ratios and their 95% confidence intervals of the CoV levels of home blood pressure on the development of all-cause dementia, vascular dementia (VaD), and Alzheimer disease (AD) were computed with a Cox proportional hazards model. During the follow-up, 194 subjects developed all-cause dementia; of these, 47 had VaD and 134 had AD. The age- and sex-adjusted incidences of all-cause dementia, VaD, and AD increased significantly with increasing CoV levels of home SBP (all P for trend <0.05). These associations remained unchanged after adjustment for potential confounding factors, including home SBP. Compared with subjects in the first quartile of CoV levels of home SBP, the risks of the development of all-cause dementia, VaD, and AD were significantly higher in those in the fourth quartile (hazard ratio=2.27, 95% confidence interval=1.45–3.55, P<0.001 for all-cause dementia; hazard ratio=2.79, 95% confidence interval=1.04–7.51, P=0.03 for VaD; hazard ratio=2.22, 95% confidence interval=1.31–3.75, P<0.001 for AD). Similar associations were observed for CoV levels of home diastolic blood pressure. Meanwhile, home SBP levels were significantly associated with the risk of VaD but not with the risks of all-cause dementia and AD. There was no interaction between home SBP levels and CoV levels of home SBP on the risk of each subtype of dementia. Our findings suggest that increased day-to-day blood pressure variability is, independently of average home blood pressure, a significant risk factor for the development of all-cause dementia, VaD, and AD in the general elderly Japanese population.