Low blood pressure and risk of dementia in the Kungsholmen project - A 6-year follow-up study
Low blood pressure and risk of dementia in the Kungsholmen project - A 6-year follow-up study
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DOI：
10.1001/archneur.60.2.223
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发表时间：
2003-02-01
影响因子：
--
通讯作者：
Fratiglioni, L
中科院分区：
文献类型：
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作者：
Qiu, CX;von Strauss, E;Fratiglioni, L
背景资料：以前的研究报道了低血压人群中痴呆的患病率更高。目的：研究低血压是否与老年人中阿尔茨海默病和痴呆的发生有前瞻性相关。一个以社区为基础，无痴呆队列（n = 1270）在6年内对75至101岁的老年人进行两次纵向检查，以使用精神障碍诊断和统计手册检测痴呆事件，修订的第三版标准。考克斯比例风险模型被用来分析血压与痴呆症调整后的几个潜在的confounders.Results：在6年期间，339名受试者被诊断为痴呆症，其中包括256人与阿尔茨海默病。收缩压极高（>180 vs 141-180 mm Hg）的受试者患阿尔茨海默病的校正相对风险为1.5（95%置信区间[CI]，1.0-2.3; P = 0.07），患痴呆的校正相对风险为1.6（95% CI，1.1-2.2）。低收缩压（小于或等于140毫米汞柱）与痴呆的发生无关。相反，高舒张压（>90 mm Hg）与痴呆发病率无关，而极低舒张压（小于或等于65 vs 66-90 mm Hg）产生的阿尔茨海默病校正相对危险度为1.7（95% CI，1.1-2.4），痴呆校正相对危险度为1.5（95% CI，1.0-2.1; P = 0.03）。后者的关联是明显的，特别是在使用抗高血压药物的人。结论：低舒张压和高收缩压与阿尔茨海默病和痴呆症的风险增加，在这个老年人群。动脉粥样硬化过程可以解释观察到的相关性。此外，低舒张压可能通过影响脑灌注而增加痴呆风险。
Background: Previous studies have reported a higher prevalence of dementia in persons with low blood pressure.Objective: To examine whether low blood pressure is prospectively associated with the occurrence of Alzheimer disease and dementia in elderly people.Subjects and Methods: A community-based, dementia-free cohort (n = 1270) aged 75 to 101 years was longitudinally examined twice within 6 years to detect incident dementia using the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria. Cox proportional hazards models were used to analyze blood pressure in association with dementia after adjustment for several potential confounders.Results: During the 6-year period, 339 subjects were diagnosed with dementia, including 256 persons with Alzheimer disease. Subjects with very high systolic pressure (>180 vs 141-180 mm Hg) had an adjusted relative risk of 1.5 (95% confidence interval [CI], 1.0-2.3; P = .07) for Alzheimer disease, and 1.6 (95% CI, 1.1-2.2) for dementia. Low systolic pressure (less than or equal to140 mm Hg) was not related to incident dementia. In contrast, high diastolic pressure (>90 mm Hg) was not associated with dementia incidence, whereas extremely low diastolic pressure (less than or equal to65 vs 66-90 mm Hg) produced an adjusted relative risk of 1.7 (95% CI, 1.1-2.4) for Alzheimer disease and 1.5 (95% CI, 1.0-2.1; P = .03) for dementia. The latter association was pronounced particularly in persons who used antihypertensive drugs.Conclusions: Both low diastolic and high systolic pressure are associated with an increased risk of Alzheimer disease and dementia in this elderly population. The atherosclerotic process may explain the observed associations. In addition, low diastolic pressure may increase dementia risk by affecting cerebral perfusion.