15-year longitudinal study of blood pressure and dementia
15-year longitudinal study of blood pressure and dementia
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DOI：
10.1016/s0140-6736(96)90608-x
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发表时间：
1996-04-27
期刊：
影响因子：
168.9
通讯作者：
Svanborg, A
中科院分区：
文献类型：
--
作者：
Skoog, I;Lernfelt, B;Svanborg, A
背景：痴呆症的血管原因可能比想象的更常见。血管因素也可能在迟发性阿尔茨海默病中起作用，但高血压在痴呆症发展中的作用尚不清楚。方法作为瑞典哥德堡70岁老年人纵向人口研究的一部分，我们分析了70-75岁、75-79岁和79-85岁非痴呆者(n=382)血压与痴呆症发展的关系。研究人员对样本进行了15年的跟踪调查，并进行了包括精神和体格检查在内的全面调查。研究发现，在79-85岁之间出现痴呆的参与者在70岁时的收缩压(平均178vs164 mm Hg，p=0.034)和在70岁时的舒张压(101vs92，p=0.004)和75岁时的舒张压(97vs90，p=0.022)都高于未患痴呆症的人。对于痴呆症的亚型，阿尔茨海默病患者在70岁(101，p=0.019)和75岁(101，p=0.019)的舒张压高于未患痴呆症的人。P=0.015)患血管性痴呆者多于未患痴呆症的人。85岁时在计算机断层扫描上有白质病变的参与者在70岁时的血压高于那些没有此类病变的参与者。在痴呆症发病前的几年中，血压下降，然后与非痴呆症患者相似或更低。以前解释的血压升高可能会导致小血管疾病和白质损害，从而增加患痴呆症的风险。痴呆症发作前血压下降在多大程度上是脑部疾病的后果或原因仍有待阐明。
Background Vascular causes of dementia may be more common than supposed. Vascular factors may also have a role in late-onset Alzheimer's disease, but the role of hypertension in the development of dementia is unclear.Methods As part of the Longitudinal Population Study of 70-year-olds in Goteborg, Sweden, we analysed the relation between blood pressure and the development of dementia in the age intervals 70-75, 75-79, and 79-85 years in those non-demented at age 70 (n=382). The sample was followed up for 15 years and examined repeatedly with a comprehensive investigation, including a psychiatric and physical examination.Findings Participants who developed dementia at age 79-85 had higher systolic blood pressure at age 70 (mean 178 vs 164 mm Hg, p=0.034) and higher diastolic blood pressure at ages 70 (101 vs 92, p=0.004) and 75 (97 vs 90, p=0.022) than those who did not develop dementia, For subtypes of dementia, higher diastolic blood pressure was recorded at age 70 (101, p=0.019) for those developing Alzheimer's disease and at age 75 (101, p=0.015) for those developing vascular dementia than for those who did not develop dementia. Participants with white-matter lesions on computed tomography at age 85 had higher blood pressure at age 70 than those without such lesions. Blood pressure declined in the years before dementia onset and was then similar to or lower than that in non-demented individuals.Interpretation Previously increased blood pressure may increase the risk for dementia by inducing small-vessel disease and white-matter lesions. To what extent the decline in blood pressure before dementia onset is a consequence or a cause of the brain disease remains to be elucidated.