背景:在美国,高血压和痴呆存在很大的种族和民族差异。我们评估了收缩压(SBP)维持在临床阈值以下对痴呆发病率的影响。
方法:我们纳入了6806名动脉粥样硬化参与者(44至84岁)的多种族研究。我们实施了参数g公式来模拟假设的干预措施,以随着时间的推移将SBP降低到120和140mmHg以下,考虑时变混杂因素。我们估计了19岁时痴呆发病率的风险比(RR)和风险差异。
结果:将SBP降至120mmHg以下的干预措施与无干预措施进行比较的RRs(95%置信区间[CI])为0.93(0.87至0.99),白色为0.95(0.88至1.02),黑色为0.90(0.79至1.02),拉丁裔为0.90(0.78至1.05),美籍华人参与者为1.16(0.83至1.55)。将SBP降低至140mmHg以下并将死亡作为竞争事件的结果减弱。
结论:随着时间的推移,SBP降低到120mmHg以下对降低痴呆发病率具有适度的作用。需要做更多的工作来了解种族和族裔群体的异质性。
结论:降低SBP对降低痴呆风险有潜在的有益作用,可能因种族和民族而异。黑人和拉丁裔社区需要干预血压以达到临床阈值的参与者比例更高。结果对研究问题和分析中指定死亡的方式很敏感。
Substantial racial and ethnic disparities in hypertension and dementia exist in the United States. We evaluated the effect of maintaining systolic blood pressure (SBP) below clinical thresholds on dementia incidence.
We included 6806 Multi-Ethnic Study of Atherosclerosis participants (44 to 84 years old). We implemented the parametric g-formula to simulate the hypothetical interventions to reduce SBP below 120 and 140 mmHg over time, accounting for time-varying confounding. We estimated risk ratios (RRs) and risk differences for dementia incidence at 19 years.
The RRs (95% confidence intervals [CIs]) comparing an intervention reducing SBP below 120 mmHg to no intervention were 0.93 (0.87 to 0.99) for total sample, 0.95 (0.88 to 1.02) for White, 0.90 (0.79 to 1.02) for Black, 0.90 (0.78 to 1.05) for Latino, and 1.16 (0.83 to 1.55) for Chinese American participants. Results for lowering SBP below 140 mmHg and with death as competing event were attenuated.
The reduction of SBP below 120 mmHg over time has modest effects on reducing dementia incidence. More work is needed to understand the heterogeneity across racial and ethnic groups.
There is a potential beneficial effect in lowering SBP to reduce the risk of dementia, which may vary by race and ethnicity. The percentage of participants who would need intervention on blood pressure to meet clinical thresholds is greater for Black and Latino communities. Results are sensitive to the way that death is specified in the research question and analysis.