中老年高血压人群H型高血压患病程度与认知功能关系分析

背景　H型高血压是指伴有高同型半胱氨酸血症的高血压，我国高血压患者众多，其中H型高血压约占75%，且发病率处于上升趋势。高血压、高同型半胱氨酸血症均为认知功能损伤的危险因素，H型高血压对患者认知功能可能造成更大损害，对患者生活质量产生更为严重的不良影响。目的　调查中老年高血压患者中H型高血压现况，分析H型高血压患病程度与认知功能的关系，为相关防控提供依据。方法　2020年3-11月，选取2007年3月-2008年11月居住在天津市5个社区（安乐村社区、咸阳路社区、龙兴里社区、尚友里社区、荣迁东里社区）及2个养老机构（天津市养老院、天津市和平区老年公寓）的97例高血压患者为研究对象。采用面对面访谈的方法收集研究对象的人口学特征：性别、年龄、受教育年限、婚姻状况、居住情况、月收入；生活方式：饮酒、吸烟、喝咖啡、饮茶以及每日饮水量、每日睡眠时间、每日锻炼时间；维生素服用情况。使用简易精神状态量表（MMSE）初步评估研究对象的认知状态，MMSE得分<26分作为轻度认知障碍（MCI）的判定标准。采用基本认知能力测验（BCAT）评估研究对象的认知功能。根据血清总同型半胱氨酸（tHcy）水平进行分组：tHcy<10 μmol/L为单纯性高血压组，10 μmol/L≤tHcy≤15 μmol/L为轻度H型高血压组，15 μmol/L30 μmol/L为重度H型高血压组。采用多重线性回归分析探讨H型高血压与认知功能的关系。结果　共检出H型高血压84例，检出率为86.60%。97例研究对象中单纯性高血压组13例（13.40%），轻度H型高血压组31例（31.96%），中度H型高血压组53例（54.64%）。中度H型高血压组居住情况与单纯性高血压组、轻度H型高血压组比较，差异有统计学意义（P<0.05）。共检出MCI患者17例（17.53%），其中单纯性高血压组检出MCI患者4例（30.77%），轻度H型高血压组检出4例（12.90%），中度H型高血压组检出9例（16.98%）。多重线性回归分析结果显示，中度H型高血压与心算得分有相关关系（P=0.028）。结论　中老年高血压患者中H型高血压患病率较高，居住在老年公寓者H型高血压的患病风险更高。H型高血压程度越严重，患者的运算能力越差。应重视对中老年高血压患者的同型半胱氨酸水平及认知功能监测，尽早防控认知功能障碍。

H-type Hypertension Severity and Cognitive Function in Middle-aged and Elderly Chinese People with Hypertension

Background　H-type hypertension refers to hypertension accompanied by hyperhomocysteinemia（HHcy）.It accounts for about 75% of all the types of hypertension and is increasing in the large number of Chinese hypertension patients.Hypertension and HHcy are both risk factors for cognitive impairment.H-type hypertension may have more serious adverse effects on cognitive function and quality of life of patients.Objective　To investigate the prevalence of H-type hypertension，and the association of its severity with cognitive function in middle-aged and elderly hypertensive patients，providing evidence for related disease prevention and control.Methods　From March to November 2020，a total of 97 patients with hypertension who lived in 5 communities（Anle Village，Xianyang Road，Longxingli，Shangyouli，Rongqiandongli） and 2 nursing homes（Tianjin Nursing Home and Heping District Apartment for the Elderly） in Tianjin were selected from March 2007 to November 2008.A face-to-face interview was conducted to collect demographic characteristics，including gender，age，years of education，marital status，residence status，monthly income，lifestyle（drinking，smoking，coffee consumption，tea consumption，daily water intake，daily sleep time，daily exercise time，and vitamin intake.The Mini-Mental State Examination（MMSE） was used to initially assess the cognitive function，by using MMSE score <26 as a criterion for mild cognitive impairment（MCI）.The Basic Cognitive Aptitude Test（BCAT） was used for further evaluating the cognitive function.The patients were divided into three groups according to the level of serum total homocysteine （tHcy）：tHcy <10 μmol/L，10 μmol/L≤ tHcy ≤15 μmol/L，15 μmol/L< tHcy ≤30μmol/L and tHcy >30 μmol/L were considered as simple hypertension，mild，and moderate H-type hypertension，respectively.Multiple linear regression was used to analyse the relationship between H-type hypertension and cognitive function.Results　The prevalence of H-type hypertension was 86.60%（84/97）.Among the 97 subjects，13（13.40%） were found with simple hypertension，31（31.96%） with mild H-type hypertension，and 53（54.64%） with moderate H-type hypertension.The residence status of moderate H-type hypertension patients was significantly different from that of those with simple hypertension or mild H-type hypertension （P <0.05）.The overall prevalence of MCI was 17.53%（17/97）.And the prevalence of MCI in simple hypertension，mild and moderate H-type hypertension patients was 30.77%（4/13），12.90%（4/31），and 16.98%（9/53），respectively.Multiple linear regression analysis demonstrated that moderate H-type hypertension was correlated with mental arithmetic score（P =0.028）.Conclusion　The prevalence of H-type hypertension was relatively high in these middle-aged and elderly patients.And the risk of H-type hypertension was higher in elderly people living in the nursing home.Increased severity of H-type hypertension may be associated with poorer calculation ability.So it is suggested to pay more attention to the monitoring of Hcy level and cognitive function in hypertensive patients to prevent and control cognitive dysfunction as soon as possible.