Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
essential_information
2021-11-20
Published articles
Journal：J Clin Hypertens (Greenwich)
Publication type: Cohort Study
IF(IF): 3.738
PMID: 34800332 Link To Pubmed Full text Download
Background And Purpose
高血压在中老年人群中具有较高的发生率，老年人作为认知障碍的高发群体，研究提示高血压可能会进一步加大认知障碍的发生率1-3，包括常见的血管病相关的认知障碍3以及阿尔茨海默症1-2等。目前血管相关的认知障碍较为常见，并且已经影响了部分卒中人群后续生活水平，增加其生活负担4-5。更多研究开始关注如何通过相关因素分析预测可能导致卒中后认知变化的危险因素及保护因素。高血压是导致卒中后认知恶化的重要因素之一3，目前较多指南推荐血压控制在140/90mmHg以下可以减少心脑血管事件发生6-7，部分研究提示降低血压有益于保护卒中后的认知水平8，也有研究发现收缩压控制在普通水平（140mmHg）或强化降压（120mmHg）均无明显差别9。我们希望通过分析患者的稳定期血压水平以及认知变化情况等结局指标变化，探索血压对卒中后认知变化等相关性。
Method
This is a sub-study of the Impairment of CognitiON and Sleep after acute ischemic stroke or transient ischemic attack in Chinese patients (ICONS) study conducted between August 2015 and March 2018. Cognition was assessed at two-week (2w), three-month (3m), and twelve-month (12m) by Montreal Cognitive Assessment (MoCA). A total of 682 participants who met the inclusion criteria were enrolled. The primary outcome was cognitive changes after 3 and 12 months post stroke.
Conclusion
SBP more than 140 mmHg is associated with worse cognitive performance after ischemic stroke. Patients with SBP lower than 140 mmHg have better cognitive outcome at 3-month and one year after stroke.
Main results
Among 682 participants, the mean age was 59.35 +10.40 years and 72.29% were men. PSCI patients with high systolic blood pressure (SBP ≥140 mmHg) at 3m not only had worse cognition as evidenced by MoCA scores at 3m but also predicted worse scores at 12m. When participants were stratified into cognitively stable/improved (MoCA score ≥0, 2w vs. 12m) and cognitively impaired (MoCA score ≤-2, 2w vs. 12m), those with high SBP were more likely to be cognitively impaired (OR 2.17, 95%CI 1.12-4.21, p <0.05) and less likely to be cognitively stable/improved (OR 0.66, 95%CI 0.44-0.99, p <0.05).