Association of systolic blood pressure variability with cognitive decline in type 2 diabetes: A post hoc analysis of a randomized clinical trial

IF 3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Journal of Diabetes Pub Date : 2024-10-29 DOI:10.1111/1753-0407.70020
Junmin Chen, Xuan Zhao, Huidan Liu, Kan Wang, Xiaoli Xu, Siyu Wang, Mian Li, Ruizhi Zheng, Libin Zhou, Yufang Bi, Yu Xu
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Abstract

Background

We aimed to explore the association between visit-to-visit systolic blood pressure variability (BPV) and cognitive function in individuals with type 2 diabetes.

Methods

We performed a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) substudy. A total of 2867 diabetes patients with ≥3 BP measurements between the 4- and 20-month visits were included. Visit-to-visit systolic BPV was calculated. Cognitive decline was defined as a Mini-Mental State Exam (MMSE), Digit Symbol Substitution Test (DSST), or Rey Auditory Verbal Learning Test (RAVLT) score greater than 1 standard deviation (SD) below the baseline mean, or a Stroop test score more than 1 SD above the baseline mean. The associations of systolic BPV with risks of cognitive decline were examined using Cox proportional hazards models, and with changes in brain magnetic resonance imaging parameters were evaluated using mixed models.

Results

The risk of cognitive decline defined by the DSST score (but not by other scores) increased significantly with systolic BPV quartiles (p for trend = 0.008), and there was a 55% increased risk for BPV quartile 4 versus quartile 1 (hazard ratio = 1.55, 95% confidence interval 1.10–2.19). Furthermore, a positive correlation was observed between systolic BPV and change in white matter lesion volume (β = 0.07, 95% CI 0.01–0.13).

Conclusions

A greater visit-to-visit systolic BPV was significantly associated with an increased risk of cognitive decline measured by DSST and an increase in white matter lesion volume in patients with type 2 diabetes.

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收缩压变化与 2 型糖尿病患者认知能力下降的关系:随机临床试验的事后分析。
研究背景我们旨在探讨2型糖尿病患者逐次收缩压变异性(BPV)与认知功能之间的关系:我们对控制心血管风险糖尿病记忆行动(ACCORD-MIND)子研究进行了事后分析。共纳入了2867名在4个月和20个月访视期间测量血压≥3次的糖尿病患者。计算各次就诊的收缩压值。认知能力下降的定义是迷你精神状态检查(MMSE)、数字符号替换测试(DSST)或雷伊听觉言语学习测试(RAVLT)得分比基线平均值低 1 个标准差以上,或 Stroop 测试得分比基线平均值高 1 个标准差以上。收缩压与认知能力下降风险的关系采用 Cox 比例危险模型进行检验,与脑磁共振成像参数变化的关系采用混合模型进行评估:根据 DSST 评分(而非其他评分)确定的认知功能下降风险随着收缩压四分位数的增加而显著增加(趋势 p = 0.008),收缩压四分位数比四分位数 1 的风险增加了 55%(危险比 = 1.55,95% 置信区间为 1.10-2.19)。此外,还观察到收缩压与白质病变体积的变化呈正相关(β = 0.07,95% CI 0.01-0.13):结论:2 型糖尿病患者每次就诊时收缩压升高与 DSST 测定的认知能力下降风险增加和白质病变体积增加显著相关。
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来源期刊
Journal of Diabetes
Journal of Diabetes ENDOCRINOLOGY & METABOLISM-
CiteScore
6.50
自引率
2.20%
发文量
94
审稿时长
>12 weeks
期刊介绍: Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.
期刊最新文献
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