老年高血压病患者治疗后血压水平与认知功能的相关性

目的:探讨长期坚持降压治疗的老年高血压病患者血压水平与认知功能的关系。方法:军队离退休老年高血压患者105例,按MMSE评分分为认知障碍组和正常组,比较两组患者治疗后血压水平及血糖、血脂、血同型半胱氨酸水平,并比较不同收缩压及舒张压水平下患者MMSE评分。结果:认知功能障碍组高血压病程、同型半胱氨酸水平明显高于认知功能正常组(P<0.01)。将高血压病程作为协变量,多因素协方差分析显示,调整高血压病程的影响后,收缩压130~149 mmHg组在MMSE总分、定向力、记忆力、注意力、回忆力、语言能力得分高于111~129 mmHg组和150~160 mmHg组。其中,130~149 mmHg组与111~129 mmHg组比较,定向力、记忆力、注意力、回忆力、语言能力及MMSE总分差异有统计学意义(P<0.01);与150~160 mmHg组比较定向力差异有统计学意义(P<0.01)。不同舒张压水平的患者认知功能比较差异无统计学意义。结论:在老年高血压患者的降压治疗中,目标收缩压水平长期控制在130~149 mmHg对认知功能可能有保护作用。

Relationship between cognitive function and different levels of blood pressure achieved in elderly patients with hypertension

AIM: To analyze the relation between cognitive functions and different levels of blood pressure achieved after treatment and to explore the influential factors of cognitive impairment in elderly hypertensive patients.METHODS: Included in the study were 105 elderly hypertensive patients who received antihypertensive drug treatment for(12±7) years.Cognitive functions were evaluated with Mini-Mental State Examination Scale(MMSE).According to MMSE scores,all subjects were divided into cognitive impaired group(n=48) and normal cognitive group(n=57).RESULTS: Significant differences were found in the duration of hypertension and plasma homocysteine levels between cognitive impaired group and normal cognitive group.Using multivariate analysis of covariance adjusting for the duration of the hypertension,MMSE scores of patients who achieved the goal SBP of 111-129 mmHg were 14.94±10.28,respectively,22.97±7.30 in 130-149 mmHg group and 20.61±8.59 in the 150-160 mmHg group.Significant differences were observed in MMSE scores in 130-149 mmHg group compared with those in 111-129 mmHg group and 150-160 mmHg group(P<0.01).No significant difference was found in diastolic blood pressure levels.CONCLUSION: Antihypertensive therapy may better protect cognitive functions in elderly hypertensive patients if SBP can be maintained at 130-150 mmHg.