65岁及以上社区老年人高血压病收缩压控制情况与认知功能关联性

邹明君; 黄建武; 曾燕; 程桂荣; 陈聪; 李琳; 刘丹

doi:10.16462/j.cnki.zhjbkz.2021.11.008

65岁及以上社区老年人高血压病收缩压控制情况与认知功能关联性

doi: 10.16462/j.cnki.zhjbkz.2021.11.008

430065 武汉，武汉科技大学医学院，武汉科技大学脑科学先进技术研究院

邹明君和黄建武为共同第一作者

基金项目:

国家自然科学基金 71774127

国家重点研发计划 2020YFC2006000

详细信息

通讯作者:
刘丹，E-mail: liudan125@wust.edu.cn

中图分类号: R544.1;R161.7
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出版历程
- 收稿日期: 2021-02-04
- 修回日期: 2021-04-29
- 网络出版日期: 2021-12-04
- 刊出日期: 2021-11-10

Association between systolic blood pressure control and cognitive function in Community-living older adults 65 years and older with hypertension

Medical College, Wuhan University of Science and Technology, Brain Science and Advanced Technology Institute, Wuhan University of Science and Technology, Wuhan 430065, China

ZOU Ming-jun and HUANG Jian-wu are contributed equally to this article

Funds:

National Natural Science Foundation of China 71774127

National Key R & D Program of China 2020YFC2006000

More Information

Corresponding author: LIU Dan, E-mail: liudan125@wust.edu.cn

摘要

摘要: 目的探究老年高血压病人SBP控制情况和认知功能的关系。方法采用多阶段整群抽样，对年龄≥65岁的社区老年人进行现场调查, 使用标准水银血压计连续两次测量右臂血压值，采用简明精神状态量表(mini-mental state examination, MMSE)评估认知功能，并采用多因素Logistic回归分析模型分析SBP控制情况和认知功能的关系。结果强化控制(SBP＜120 mm Hg)(OR=1.519，95% CI：1.187~1.945)增高认知障碍患病风险。年龄分层发现，强化控制增加70岁及以上老人的认知障碍患病风险(均有P < 0.05)。对高血压病史分层发现，10年以上高血压病程老人，强化控制和控制不良(SBP≥140 mm Hg)均与认知障碍患病率增加正相关(均有P < 0.05)。进一步对10年以上高血压病程老人年龄分层，发现65~69岁老人中，控制不良与认知障碍患病风险增加相关(P=0.023)。结论高血压病程较长的老人中，65~69岁老人应严格控制SBP，70岁及以上老人应谨慎控制SBP。
- SBP /
- 认知障碍 /
- 高血压病 /
- 老年人 /
- 多中心调查
Abstract: Objective To explore the relationship between systolic blood pressure (SBP) control and cognitive impairment (CI) in older adults with hypertension. Methods Randomized multistage stratified cluster sampling was used to investigate older adults 65 years of age or older in the community. Mercury sphygmomanometer was used to measure the blood pressure of the right arm twice, and mini-mental state examination (MMSE) was used to assess cognitive function. Multiple Logistic regression model was used to analyze the association between SBP control and cognitive function. Results Intensive control (SBP < 120 mm Hg) (OR=1.519, 95% CI: 1.187-1.945) increased the risk of cognitive impairment. When participants were stratified according to age, intensive control was significantly associated with increased risk of CI in older adults 70 years of age or older (all P < 0.05). After participants were stratified by duration of hypertension, we found that intensive control and poor control (SBP > 140 mm Hg) were significantly associated with increased risk of CI (both P < 0.05) in older adults with hypertension over ten years. Further stratified by age, poor control was associated with an increased risk of CI in older adults 65-69 years of age (P=0.021). Conclusions In older adults with long duration of hypertension, people aged 65-69 years of age should strictly control SBP, and those aged 70 years of age or older should carefully control SBP.
- Systolic blood pressure /
- Cognition impairment /
- Hypertension /
- Older adults /
- Multicenter survey

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表 1 患有高血压的老年人基本特征[n (%)]

Table 1. Basic characteristics of the older adults with hypertension [n (%)]

基本特征	总体 (N=5 414)	SBP控制不良 (n=3 318)	SBP标准控制 (n=1 696)	SBP强化控制 (n=400)	H/χ²值	P值
女性	2 935(54.21)	1 781(53.68)	9 39(55.37)	215(53.75)	1.32	0.515
年龄(岁)					57.15	< 0.001
65~＜70	1 880(34.72)	1 067(32.16)	648(38.21)	165(41.25)
70~＜75	1 368(25.27)	813(24.50)	436(25.71)	119(29.75)
75~＜80	1 133(20.93)	720(21.70)	347(20.46)	66(16.50)
≥80	1 033(19.08)	718(21.64)	265(15.63)	50(12.50)
教育水平					11.77	0.067
文盲	650(12.01)	415(12.51)	200(11.79)	35(8.75)
小学	774(14.30)	496(14.95)	226(13.33)	52(13.00)
中学	1 929(35.63)	1 139(34.33)	638(37.62)	152(38.00)
大学及以上	2 061(38.07)	1 268(38.22)	632(37.26)	161(40.25)
居住地农村	1 243(22.96)	747(22.51)	390(23.00)	106(26.50)	3.21	0.201
重度吸烟	1 006(18.58)	587(17.69)	339(19.99)	80(20.00)	4.49	0.106
重度饮酒	979(18.08)	586(17.66)	315(18.57)	78(19.50)	1.21	0.545
运动强度					43.95	< 0.001
低强度	1 157(21.37)	789(23.78)	294(17.33)	74(18.50)
中强度	3 040(56.15)	1 753(52.83)	1 049(61.85)	238(59.50)
高强度	1 217(22.48)	776(23.39)	353(20.81)	88(22.00)
肥胖	782(14.44)	506(15.25)	229(13.50)	47(11.75)	5.31	0.070
糖尿病	1 114(20.58)	680(20.49)	350(20.64)	84(21.00)	0.06	0.970
高血压病史(x±s, 年)	14.4±11.5	14.9±11.8	13.9±11.1	12.8±10.7	12.02	0.002
SBP(x±s, mm Hg)	145.3±20.7	157.4±16.0	130.1±5.7	110.0±9.0	4 002.45	< 0.001
DBP(x±s, mm Hg)	81.2±12.3	84.4±12.3	77.3±9.5	70.2±11.3	742.23	< 0.001
认知障碍	1 405(25.95)	875(26.37)	407(24.00)	123(30.75)	8.47	0.015

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表 2 SBP控制情况与认知障碍的关系[n (%)]

Table 2. The association between systolic blood pressure control and cognitive impairment [n (%)]

年龄	SBP标准控制(对照)	SBP控制不良			SBP强化控制
年龄	认知障碍/总数	认知障碍/总数	OR (95% CI)值	P值	认知障碍/总数	OR (95% CI)值	P值
总体^a	407/1 696 (24.00)	875/3 318 (26.37)	1.088 (0.946~1.251)	0.237	123/400 (30.75)	1.519 (1.187~1.945)	< 0.001
65~＜70 ^b	132/648 (20.37)	220/1 067 (20.62)	1.037 (0.811~1.325)	0.772	28/165 (16.97)	0.818 (0.518~1.291)	0.388
70~＜75 ^b	102/436 (23.39)	225/813 (27.68)	1.240 (0.940~1.636)	0.128	40/119 (33.61)	1.748 (1.110~2.751)	0.016
75~＜80 ^b	85/347 (24.50)	182/720 (25.28)	1.054 (0.776~1.431)	0.738	26/66 (39.39)	2.340 (1.319~4.151)	0.003
≥80 ^b	88/265 (33.21)	248/718 (34.54)	1.053 (0.774~1.432)	0.742	29/50 (58.00)	2.977 (1.576~5.622)	< 0.001
注：^a校正年龄、性别、教育、抽烟、肥胖、体力活动；^b对年龄分层，校正性别、教育、抽烟、肥胖、体力活动。

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表 3 高血压病患病年限对SBP控制情况与认知障碍关系的影响[n (%)]

Table 3. The effect of duration of hypertension on the association between systolic blood pressure control and cognitive impairment [n (%)]

高血压病患病年限	年龄	SBP标准控制(对照)	SBP控制不良			SBP强化控制
高血压病患病年限	年龄	认知障碍/总数	认知障碍/总数	OR (95% CI)值	P值	认知障碍/总数	OR (95% CI)值	P值
＜10年	总体^a	162/709(22.85)	333/1 368(24.34)	1.018(0.814~1.274)	0.876	45/178(25.28)	1.223(0.824~1.817)	0.318
	65~＜70 ^b	59/292(20.21)	91/473(19.24)	0.952(0.655~1.383)	0.795	15/72(20.83)	1.099(0.572~2.111)	0.778
	70~＜75 ^b	39/185(21.08)	93/366(25.41)	1.227(0.790~1.905)	0.362	15/61(24.59)	1.276(0.632~2.579)	0.497
	75~＜80 ^b	32/138(23.19)	60/265(22.64)	0.905(0.535~1.531)	0.710	8/28(28.57)	1.672(0.612~4.569)	0.317
	≥80 ^b	32/94(34.04)	89/264(33.71)	0.988(0.586~1.667)	0.964	7/17(41.18)	1.324(0.441~3.977)	0.617
≥10年	总体^a	114/659(17.30)	305/1 373(22.21)	1.391(1.085~1.784)	0.009	40/143(27.97)	2.229(1.440~3.450)	< 0.001
	65~＜70 ^b	28/223(12.56)	68/379(17.94)	1.785(1.085~2.937)	0.023	5/53(8.62)	0.814(0.290~2.284)	0.696
	70~＜75 ^b	27/163(16.56)	70/311(22.51)	1.426(0.853~2.384)	0.176	13/26(33.33)	3.149 (1.363~7.277)	0.007
	75~＜80 ^b	23/140(16.43)	63/326(19.33)	1.318(0.759~2.287)	0.327	10/25(40.00)	4.184(1.576~11.104)	0.004
	≥80 ^b	36/133(27.07)	104/357(29.13)	1.218(0.767~1.936)	0.404	9/21(57.14)	4.289(1.597~11.523)	0.004
注：^a在该分析中删除高血压患病年限缺失者984人，对剩下的4 430人进一步分析，校正年龄、性别、教育、抽烟、肥胖、体力活动；^b对年龄分层，校正性别、教育、抽烟、肥胖、体力活动。

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