老年高血压患者体位性低血压与认知功能障碍的关系

Relationship of orthostatic hypotension and cognitive dysfunction in elderly patients with hypertension

目的 探讨老年高血压患者体位性低血压(OH)与认知功能障碍的关系。方法 165例老年高血压患者中,存在OH的患者(OH组)49例,无OH的患者(NOH组)116例。记录两组基本临床资料和生化指标,采用蒙特利尔认知评估量表(MoCA)筛查认知功能障碍,并分析老年高血压患者发生认知功能障碍的影响因素。结果 两组年龄、BMI、收缩压、舒张压、受教育年限、慢性疾病种类以及冠心病、心力衰竭、糖尿病、服用硝酸酯类药物的患者比例差异有统计学意义(P<0.01)。与NOH组相比,OH组同型半胱氨酸水平较高,TG、TC、载脂蛋白B、LDL-C和白蛋白水平较低(P<0.05)。OH组MoCA评分低于NOH组[(16.47±3.65)分vs.(21.24±3.38)分](P<0.05);OH组认知功能障碍的发生率高于NOH组(75.5%vs. 51.7%)(P<0.05)。多因素logistic回归分析显示,BMI较低、MoCA评分较低、存在OH和受教育年限较短是老年高血压患者发生认知功能障碍的独立危险因素(P<0.05)。结论 老年高血压患者的OH与认知功能障碍相关。

Objective To investigate the relationship between orthostatic hypotension(OH)and cognitive dysfunction in elderly patients with hypertension.MethodsOf 165 elderly patients with hypertension,49 cases had OH(group OH),and 116 cases had no OH(group NOH).The basic clinical data and biochemical indexes were recorded in both groups.The cognitive dysfunction was determined by Montreal Cognitive Assessment(MoCA).The factors influencing the cognitive dysfunction in elderly patients with hypertension was then analyzed.ResultsThere were significant differences in the age,BMI,systolic pressure,diastolic pressure,education years,types of chronic diseases,and percentages of coronary heart disease,heart failure,diabetes mellitus and taking nitric acid ester between groups of OH and NOH(P<0.01).Compared with group NOH,group OH had higher level of Hcy,and lower levels of TG,TC,apolipoprotein B,LDL-C and albumin(P<0.05).The MoCA score in group OH was less than that in group NOH[(16.47±3.65)points vs.(21.24±3.38)points](P<0.05),while the incidence of cognitive dysfunction was higher than that in group NOH(75.5%vs.51.7%)(P<0.05).The multivariate logistic regression analysis showed that the lower BMI,less MoCA score,OH and shorter education years were the independent risk factors for the cognitive dysfunction in elderly patients with hypertension(P<0.05).Conclusion OH is associated with cognitive dysfunction in elderly patients with hypertension.