背景:高血压是老年人轻度认知障碍(MCI)的既定危险因素。然而,不同血压水平对MCI进展的影响尚不确定.本研究旨在探讨老年人血压与MCI的非线性关系,并检测其临界血压阈值,因此,改善MCI高危人群的血压管理。
方法:数据来自中国纵向健康长寿调查(CLHLS)队列。我们选择了2014年进入队列的正常认知老年人,进行了5年的随访,以观察MCI的进展。随后,我们使用Cox回归模型来识别MCI的危险因素,并使用基于Cox的限制性三次样条回归(RCS)模型来检验收缩压(SBP)和舒张压(DBP)与MCI之间的非线性关系,从而确定MCI进展的临界血压阈值.
结果:在老年人群中,女性(HR=1.489,95%CI:1.017-2.180),过去缺乏锻炼(HR=1.714,95%CI:1.108-2.653),更喜欢动物脂肪(HR=2.340,95%CI:1.348-4.061),年龄增加(HR=1.061,95%CI:1.038-1.084),SBP增加(HR=1.036,95%CI:1.024-1.048),DBP升高(HR=1.056,95%CI:1.031-1.081)与MCI进展相关。在调整了性别等因素后,锻炼,首选类型的脂肪,和年龄,老年人SBP(P非线性<0.001)和DBP(P非线性<0.001)均与MCI呈非线性相关.当SBP超过135mmHg,DBP在80-88mmHg范围内时,MCI的风险增加。然而,当DBP超过88mmHg时,MCI进展呈下降趋势,尽管HR保持在1以上。确定的MCI的临界血压管理阈值为135/80mmHg。
结论:在这项研究中,我们发现,影响老年人MCI进展的危险因素包括性别(女性),更喜欢使用动物脂肪,过去缺乏锻炼,年龄增长,SBP增加,增加DBP。此外,证实了血压水平与MCI进展之间的非线性关系,MCI发病的关键血压管理阈值落在高血压前期范围内。
BACKGROUND: Hypertension is an established risk factor for mild cognitive impairment (MCI) in elderly individuals. Nevertheless, the impact of different levels of blood pressure on the progression of MCI remains uncertain. This study aims to investigate the non-linear relationship between blood pressure and MCI in the elderly and detect the critical blood pressure threshold, thus, improving blood pressure management for individuals at high risk of MCI.
METHODS: Data was obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) cohort. We chose normal cognitive elderly individuals who entered the cohort in 2014 for a 5-year follow-up to observe the progression of MCI. Subsequently, we utilized the Cox regression model to identify risk factors for MCI and conducted a Cox-based restricted cubic spline regression (RCS) model to examine the non-linear relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) with MCI, determining the critical blood pressure threshold for MCI progression.
RESULTS: In the elderly population, female (HR = 1.489, 95% CI: 1.017-2.180), lacking of exercise in the past (HR = 1.714, 95% CI: 1.108-2.653), preferring animal fats (HR = 2.340, 95% CI: 1.348-4.061), increased age (HR = 1.061, 95% CI: 1.038-1.084), increased SBP (HR = 1.036, 95% CI: 1.024-1.048), and increased DBP (HR = 1.056, 95% CI: 1.031-1.081) were associated with MCI progression. After adjusting factors such as gender, exercise, preferred types of fats, and age, both SBP (P non-linear < 0.001) and DBP (P non-linear < 0.001) in elderly individuals exhibited a non-linear association with MCI. The risk of MCI rose when SBP exceeded 135 mmHg and DBP was in the range of 80-88 mmHg. However, when DBP exceeded 88 mmHg, there was a declining trend in MCI progression, although the HR remained above 1. The identified critical blood pressure management threshold for MCI was 135/80 mmHg.
CONCLUSIONS: In this study, we discovered that risk factors affecting the progression of MCI in elderly individuals comprise gender (female), preferring to use animal fat, lack of exercise in the past, increased age, increased SBP, and increased DBP. Additionally, a non-linear relationship between blood pressure levels and MCI progression was confirmed, with the critical blood pressure management threshold for MCI onset falling within the prehypertensive range.