Excessive Lowering of Blood Pressure Is Not Beneficial for Progression of Brain White Matter Hyperintensive and Cognitive Impairment in Elderly Hypertensive Patients: 4-Year Follow-Up Study
Excessive Lowering of Blood Pressure Is Not Beneficial for Progression of Brain White Matter Hyperintensive and Cognitive Impairment in Elderly Hypertensive Patients: 4-Year Follow-Up Study
复制标题
过度降低血压对老年高血压患者脑白质高血压和认知障碍的进展无益：4年随访研究
DOI：
10.1016/j.jamda.2014.07.005
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发表时间：
2014-12-01
影响因子：
7.6
通讯作者：
Zhang, Wei
中科院分区：
文献类型：
--
作者：
Peng, Jie;Lu, Fanghong;Zhang, Wei
目的：本研究的目的是探讨适当的血压（BP）的目标，以减少认知能力下降和脑白色物质病变（WMLs）在老年高血压patients.Methods：老年患者（n - 294，>= 80岁）正在接受治疗的高血压纳入一项纵向研究，检查认知功能障碍后，初步评估和为期4年。所有患者均接受神经和认知评估、实验室检查和脑部磁共振成像。4年的随访检查显示，体重指数、饮酒量、收缩压（SBP）、舒张压和简易精神状态检查（MMSE）均显示出显著下降，而空腹血糖、白色高信号（WMH）体积、WMH/颅内总容积（TIV）比值与基线观察值相比显著增加。SBP在140 ~ 160 mm Hg的患者MMSE下降幅度、WMH和WMH/TIV比值的增加幅度均小于SBP低于140 mm Hg或高于160 mm Hg的患者（P <0.05）。此外，我们观察到，老年患者的SBP目标降低15至35 mm Hg比达到低于15 mm Hg或高于35 mm Hg的治疗更有利于我们的认知分析结论：在老年高血压患者中，存在降低SBP的有益目标，超过该目标，治疗可能不利于改善或延迟认知损害和WML的进展。(C)2014年AMDA -急性后和长期护理医学协会。
Objectives: This study was designed to explore the appropriate blood pressure (BP) target required to reduce cognitive decline and brain white matter lesions (WMLs) in elderly hypertensive patients.Methods: Elderly patients (n - 294, >= 80 years of age) being treated for hypertension were enrolled in a longitudinal study examining cognitive impairment after an initial assessment and a period of 4 years. All patients underwent neurological and cognitive assessment, laboratory examination, and magnetic resonance imaging of the brain.Results: The 4-year follow-up examination revealed that body mass index, alcohol consumption, systolic blood pressure (SBP), diastolic blood pressure, and Mini-Mental State Examination (MMSE) all showed a significant decline, whereas fasting plasma glucose, white matter hyperintensities (WMH) volume, and the WMH/total intracranial volume (TIV) ratio were significantly increased when compared with baseline observations. Interestingly, the decline in MMSE, as well as the increment of WMH and WMH/TIV ratio was smaller in patients with SBP ranging from 140 to 160 mm Hg than in those whose SBP was lower than 140 mm Hg or higher than 160 mm Hg (P < .05). Furthermore, we observed that a 15 to 35 mm Hg targeted lowering of SBP in the elderly patients was more beneficial to our cognitive analysis than treatments that achieved less than 15 mm Hg or greater than 35 mm Hg (P < .05).Conclusions: In elderly hypertensive patients, there exists a beneficial target for SBP lowering beyond which treatment may not be beneficial for improving or delaying the progression of cognitive impairment and WMLs. (C) 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.