Orthostatic blood pressure changes do not influence cognitive outcomes following intensive blood pressure control

IF 9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Internal Medicine Pub Date : 2023-12-18 DOI:10.1111/joim.13758

Chao Jiang, Manlin Zhao, Mingxiao Li, Zhiyan Wang, Yu Bai, Hang Guo, Sitong Li, Yiwei Lai, Yufeng Wang, Mingyang Gao, Liu He, Xueyuan Guo, Songnan Li, Nian Liu, Chenxi Jiang, Ribo Tang, Deyong Long, Caihua Sang, Xin Du, Jianzeng Dong, Craig S. Anderson, Changsheng Ma

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Abstract

Background

Effects of intensive blood pressure (BP) control on cognitive outcomes in patients with excess orthostatic BP changes are unclear. We aimed to evaluate whether orthostatic BP changes modified the effects of BP intervention on cognitive impairment.

Methods

We analyzed 8547 participants from the Systolic Blood Pressure Intervention Trial Memory and cognition IN Decreased Hypertension. Associations between orthostatic BP changes and incident cognitive outcomes were evaluated by restricted cubic spline curves based on Cox models. The interactions between orthostatic BP changes and intensive BP intervention were assessed.

Results

The U-shaped associations were observed between baseline orthostatic systolic BP changes and cognitive outcomes. However, there were insignificant interactions between either change in orthostatic systolic BP (P for interaction = 0.81) or diastolic BP (P for interaction = 0.32) and intensive BP intervention for the composite outcome of probable dementia or mild cognitive impairment (MCI). The hazard ratio of intensive versus standard target for the composite cognitive outcome was 0.82 (95% CI 0.50–1.35) in those with an orthostatic systolic BP reduction of >20 mmHg and 0.41 (95% CI 0.21–0.80) in those with an orthostatic systolic BP increase of >20 mmHg. Results were similar for probable dementia and MCI. The annual changes in global cerebral blood flow (P for interaction = 0.86) consistently favored intensive BP treatment across orthostatic systolic BP changes.

Conclusion

Intensive BP control did not have a deteriorating effect on cognitive outcomes among hypertensive patients experiencing significant postural BP changes.

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强化血压控制后，直立性血压变化不会影响认知结果。

背景：强化血压控制对正压变化过大的患者认知结果的影响尚不明确。我们旨在评估正静态血压变化是否会改变血压干预对认知障碍的影响：我们分析了 8547 名收缩压干预试验（Systolic Blood Pressure Intervention Trial Memory and cognition IN Decreased Hypertension）的参与者。通过基于 Cox 模型的限制性立方样条曲线评估了正压变化与认知结果事件之间的关联。评估了正压变化与强化降压干预之间的相互作用：结果：观察到基线收缩压正压变化与认知结果之间存在 U 型关联。然而，对于可能痴呆或轻度认知障碍（MCI）的综合结果，正压收缩压变化（交互作用 P = 0.81）或舒张压变化（交互作用 P = 0.32）与强化血压干预之间的交互作用并不显著。在正压收缩压降低 >20 mmHg 的人群中，强化目标与标准目标对复合认知结果的危险比为 0.82（95% CI 0.50-1.35）；在正压收缩压升高 >20 mmHg 的人群中，强化目标与标准目标对复合认知结果的危险比为 0.41（95% CI 0.21-0.80）。可能痴呆症和 MCI 的结果相似。全球脑血流量的年度变化（交互作用 P = 0.86）始终有利于强化血压治疗，而不受正压收缩压变化的影响：结论：在体位性血压发生显著变化的高血压患者中，强化血压控制不会对认知结果产生恶化影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Internal Medicine 医学-医学：内科

CiteScore

22.00

自引率

0.90%

发文量

176

审稿时长

4-8 weeks

期刊介绍： JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.