Hypertension and the risk of mild cognitive impairment
Hypertension and the risk of mild cognitive impairment
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DOI：
10.1001/archneur.64.12.1734
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发表时间：
2007-12-01
影响因子：
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通讯作者：
Luchsinger, Jose A.
中科院分区：
文献类型：
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作者：
Reitz, Christiane;Tang, Ming-Xin;Luchsinger, Jose A.
目的：由于高血压与阿尔茨海默病风险之间存在相互矛盾的数据，因此探讨高血压是否与轻度认知损害(MCI)的风险相关。设计和地点：在曼哈顿北部进行前瞻性社区队列研究。对918例非遗忘型MCI患者进行多因素比例风险回归分析，将高血压与发生的全因MCI、遗忘性MCI和非遗忘性MCI联系起来，平均随访4.7年。结果：在4337人年的随访中，发生MCI 334例，遗忘性MCI 160例，非遗忘性MCI 174例。高血压与全因MCI(危险比，1.40；95%可信区间，1.06-1.77；P=.02)和非遗忘性MCI(危险比，1.70；95%可信区间，1.13-2.42；P=.009)在根据年龄和性别进行调整后。在对中风和其他血管风险因素进行额外调整的模型中，这两种相关性都略有减弱。高血压与遗忘型MCI的风险之间没有关联(风险比，1.10；95%可信区间，0.79-1.63；P=.49)。与这种关联一致的是，高血压与执行能力分数的变化斜率有关，而与记忆或语言分数无关。APOE epsilon 4基因和降压药物的使用不能有效地改变高血压与MCI之间的关联。结论：高血压病史与MCI的高风险有关。在老年人中，与非遗忘型MCI的关联似乎比遗忘型MCI更强。这些发现表明，高血压的预防和治疗可能在降低认知障碍风险方面产生重要影响。
Objective: To explore whether hypertension is associated with the risk of mild cognitive impairment (MCI), an intermediate stage of dementia, because there are conflicting data relating hypertension to the risk of Alzheimer disease.Design and Setting: Prospective community-based cohort study conducted in northern Manhattan. Multivariate proportional hazards regression analyses were used, relating hypertension to incident all-cause MCI, amnestic MCI, and nonamnestic MCI in 918 persons without prevalent MCI at baseline followed up for a mean of 4.7 years.Results: There were 334 cases of incident MCI, 160 cases of amnestic MCI, and 174 cases of nonamnestic MCI during 4337 person-years of follow-up. Hypertension was associated with an increased risk of all-cause MCI (hazard ratio, 1.40; 95% confidence interval, 1.06-1.77; P=.02) and nonamnestic MCI (hazard ratio, 1.70; 95% confidence interval, 1.13-2.42; P=. 009) after adjusting for age and sex. Both associations were slightly attenuated in models additionally adjusting for stroke and other vascular risk factors. There was no association between hypertension and the risk of amnestic MCI (hazard ratio, 1.10; 95% confidence interval, 0.79-1.63; P=.49). Consistent with this association, hypertension was related with the slope of change in an executive ability score, but not with memory or language score. There was no effect modification of the association between hypertension and MCI by APOE epsilon 4 genotype or use of antihypertensive medication.Conclusions: A history of hypertension is related to a higher risk of MCI. The association seems to be stronger with the nonamnestic than the amnestic type of MCI in the elderly. These findings suggest that prevention and treatment of hypertension may have an important impact in lowering the risk of cognitive impairment.