Change in blood pressure and incident dementia: a 32-year prospective study.
Change in blood pressure and incident dementia: a 32-year prospective study.
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DOI：
10.1161/hypertensionaha.109.128744
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发表时间：
2009-08
期刊：
影响因子：
--
通讯作者：
Launer LJ
中科院分区：
文献类型：
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作者：
Stewart R;Xue QL;Masaki K;Petrovitch H;Ross GW;White LR;Launer LJ
关于高血压与痴呆之间关系的研究并不一致。了解那些患有和没有患痴呆症的人的血压的长期轨迹可以帮助澄清这个问题。檀香山心脏项目/檀香山-亚洲老龄化研究对一组日裔美国男性进行了平均32年的跟踪调查，他们在六次检查中测量了收缩压和舒张压，在最后三次检查中评估了痴呆症。在对1890名完成所有六项检查的男性的分析中，112名在第六项检查中被诊断为偶发性痴呆，与1778名没有痴呆症的幸存者进行比较。通过使用3样条重复测量分析，估计收缩压和舒张压直到和包括第六次检查的轨迹。从中年到晚年，与没有痴呆症的幸存者相比，患有痴呆症的男性每年的收缩压增加0.26 (95% CI 0.01-0.51) mmHg。在晚年检查中，该组的收缩压每年额外下降1.36 (0.64-2.07)mmHg。这些相关性在血管性痴呆中最强，而在先前服用抗高血压药物的男性中则显著降低。类似的舒张压变化也被观察到，但仅在血管性痴呆患者中，并且抗高血压治疗并未改变这一发现。在32年的时间里，与没有患痴呆症的男性相比，那些患痴呆症的男性血压增加得更大，随后收缩压下降得更大。抗高血压治疗可改变这两种趋势。
Studies of the association of high blood pressure [BP] to dementia are not consistent. Understanding long term trajectories in blood pressure of those who do and do not develop dementia can help clarify the issue. The Honolulu Heart Program/Honolulu-Asia Aging Study followed a cohort of Japanese American men for an average of 32 years, with systolic and diastolic BP measured at six examinations and dementia assessed at the final three. In an analysis of 1890 men who completed all six exams, 112 diagnosed with incident dementia at exam 6 were compared to the 1778 survivors without dementia. Trajectories in systolic and diastolic BP up to and including the sixth examination were estimated with a repeated measures analysis using 3 splines. From mid- to late-life, men who went on to develop dementia had an additional age-adjusted increase in systolic BP of 0.26 (95% CI 0.01-0.51) mmHg per year compared to survivors without dementia. Over the late-life examinations this group had an additional age-adjusted decline in systolic BP of 1.36 (0.64-2.07) mmHg per year. These associations were strongest for vascular dementia, and were reduced substantially in men who were previously taking antihypertensive medication. Similar changes in diastolic BP were observed but only for vascular dementia and the findings were not modified by antihypertensive treatment. Over a 32-year period, compared to men who did not, those who did develop dementia have had a greater increase, followed by a greater decrease in systolic BP. Both these trends are modified by antihypertensive therapy.