高血压患者直立性低血压与认知功能减退相关

Orthostatic hypotension is associated with cognitive impairment in hypertensive patients

目的 研究高血压患者直立性低血压与认知功能减退的关系。方法 磁共振检查无脑卒中及脑白质脱髓鞘的原发性高血压患者175例,其中男性87例（49.7%）,年龄50-80（65.6±8.6）岁,初中及以上文化程度140例（占80.0%）。测量卧位、立位血压,以卧位转为立位3min内收缩压下降≥20mmHg和（或）舒张压下降≥10mmHg为直立性低血压（OH）的诊断标准。应用简易精神状态量表（MMSE）评估认知功能,以MMSE得分低于分界值（文盲≤17分,小学文化程度≤20分,初中及以上文化程度≤24分）为认知功能减退的标准,分析OH与认知功能减退的关系。结果 患者175例中MMSE得分低于分界值44例（25.1%）,符合OH标准40例（22.8%）。OH组认知功能减退发生率高于非OH组（47.5%比18.5%,P=0.001）。OH组MMSE得分低于非OH组（23.68±3.37比25.95±2.93,P=0.001）。MMSE得分与卧-立位收缩压降幅呈负相关（r=-0.211,P=0.015）。单因素及多因素分析显示,与认知功能减退相关的因素有：年龄、受教育年限和OH[OR（95%CI）分别为1.08（1.03-1.13）,0.89（0.81-0.99）,3.56（1.61-7.90）,均P〈0.05]。结论 OH可能是高血压患者认知功能减退的独立危险因素。

Objective To explore the relationship between orthostatic hypotension（OH）and cognitive impairment in hypertensive patients. Methods A total of 175 primary hypertension patients with mean age of 65.6years（range：50to 80years）and without a history of stroke or leukoencephalopathy diagnosed with brain magnetic resonance imaging（MRI）were enrolled. Eighty-seven patients were male（49.7%）and 80.0% of patients underwent more than a middle school education. The blood pressure on both supine and standing position were measured.OH was defined as a decreased in systolic blood pressure（SBP）≥20 mmHg and/or decreased in diastolic blood pressure（DBP）≥10mmHg within 3minutes after standing up. The mini mental state scale（MMSE）was used to evaluate cognitive function.The criteria of cognitive impairment was defined as the MMSE score≤17points for illiterate,≤20points for primary school graduates and ≤24points for middle school education and above. The relationship between OH and cognitive impairment was analysed. Results Forty-four patients had cognitive impairment,the prevalence of cognitive impairment was 25.1%. There were 40 patients who met OH criteria（22.8%）.The incidence of cognitive impairment in OH group was significantly higher than that in non-OH group（47.5% vs18.5%,P=0.001）. The MMSE score was lower in OH group than that in non-OH group（23.68±3.37vs25.95±2.93,P =0.001）. The MMSE score was negatively correlated with SBP decline after standing up（r=-0.211,P=0.015）. Univariate and Mutivariable analyses showed that the factors associated with cognitive impairment included age,education and OH [OR（95% CI）was 1.08（1.03-1.13）,0.89（0.81-0.99）and 3.56（1.61-7.90）respectively,all P〈0.05]. Conclusion OH may be an independent risk factor for cognitive impairment in hypertensive patients.