Hypertension:警惕!即使是无症状,直立性低血压也可增加痴呆风险!

2021-09-20 MedSci原创 MedSci原创

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直立性低血压(OH)是老年人的一种常见症状,反映了血液动力学对体位变化。OH一般可分为由神经退行性疾病(如帕金森病)引起的神经源性OH和由其他因素引起的非神经源性OH

然而,OH患者临床表现差异较大,轻者可无任何症状,有症状者多在站立后几分钟内出现全身乏力、疲倦、发抖、焦虑、恶心等先兆症状,严重时晕厥,卧位后症状逐渐缓解。

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OH临床表现与各器官灌注不足有关,脑灌注不足时表现为眩晕、视力受损、昏厥等但大多数OH患者并没有报告任何与脑灌注不足有关的症状,这表明脑血管自动调节的个体间差异很大。

近日,发表在 Hypertension杂志的一项研究显示,OH与痴呆风险增加有关,即使在没有OH症状的情况下。研究人员表示,OH可能预示着老年时认知能力更差。

在这项研究中,研究人员使用了来自瑞典国家 Kungshomen 老龄化和护理研究 (SNAC-K) 的数据,该研究对大约 2500 名受试者(年龄≥60 岁)进行了定期随访。在随访开始时,医生测量了参与者躺下时和躺下五分钟后起身时的血压,并将参与者分为2组:OH组和对照组。

结果发现,在随访12年期间,322 名(12.7%)参与者发展为痴呆,其中 211 名(8.3%)患有 AD。控制人口统计学因素后,OH 与痴呆和 AD 风险增加显着相关,并且在进一步控制血管危险因素、运动功能以及合并心脏病和脑血管疾病后,这种关联仍然相似。与轻度 OH 相比,严重 OH 与痴呆和 AD 的相关性更强。10% OH 患者发展为痴呆的时间为基线后9 年,而没有 OH 的患者为 10.5 年。

直立性低血压(OH)与痴呆症发生率之间的关系

OH 相关症状的进一步分析表明,与无症状 OH 相比,有症状的 OH 与痴呆的相关性更强;然而,调整所有混杂因素后,与症状性 OH 的关联不再显著。此外,基线时有症状或无症状的 OH 均与 CIND 发生显著相关。

敏感性分析表明,当使用更严格的定义来定义OH 时,OH 与痴呆、AD CIND 进展为痴呆和 AD 的关联性更强。此外,症状性 OH 与痴呆和 CIND 进展为痴呆的风险升高显着相关。

无症状和有症状的直立性低血压(OH)与认知功能的关系

此外,根据可能的病因划分 OH 时,结果显示非神经源性和神经源性 OH 均与痴呆风险增加显著相关,而只有非神经源性 OH CIND 进展为痴呆和 AD 显著相关。

总之,老年人应该积极评估自己的体位血压,这一点尤其重要,因为体位性低血压通常是无症状的,许多患有这种疾病的老年人可能不会寻求医疗帮助。该研究表明,体位性低血压,即使是无症状的,似乎对老年人的认知功能(例如记忆和思维)有害。同时,医护人员应注意体位性低血压的检测,如果发现体位性低血压,应及时提供干预建议。

原始出处

Xin Xia et al, From Normal Cognition to Cognitive Impairment and Dementia: Impact of Orthostatic HypotensionHypertension (2021). DOI: 10.1161/HYPERTENSIONAHA.121.17454

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  5. 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  6. 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  7. 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GetPortalCommentsPageByObjectIdResponse(id=1246289, encodeId=f005124628994, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Mon Sep 20 17:43:45 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1729120, encodeId=262d1e2912085, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue Apr 05 11:43:45 CST 2022, time=2022-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039275, encodeId=1fc820392e5c0, content=<a href='/topic/show?id=b45d1e274e8' target=_blank style='color:#2F92EE;'>#TENS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17274, encryptionId=b45d1e274e8, topicName=TENS)], attachment=null, authenticateStatus=null, createdAvatar=, 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053344, encodeId=cd211053344f6, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=665c5437577, createdName=ms2000001147815163, createdTime=Mon Sep 20 20:41:06 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053306, encodeId=e9f51053306cc, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200822/b4ea7b614a2f44058d2ee7550da5aa99/0a410f15b95946019df4b84086b90665.jpg, createdBy=64642447770, createdName=123eaf1bm35暂无, createdTime=Mon Sep 20 18:20:09 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1246289, encodeId=f005124628994, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Mon Sep 20 17:43:45 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
    2021-09-20 ms2000001147815163

    学到了

    0

  9. 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    2021-09-20 123eaf1bm35暂无

    学习了

    0

  10. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053344, encodeId=cd211053344f6, content=学到了, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=665c5437577, createdName=ms2000001147815163, createdTime=Mon Sep 20 20:41:06 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1053306, encodeId=e9f51053306cc, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200822/b4ea7b614a2f44058d2ee7550da5aa99/0a410f15b95946019df4b84086b90665.jpg, createdBy=64642447770, createdName=123eaf1bm35暂无, createdTime=Mon Sep 20 18:20:09 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1246289, encodeId=f005124628994, content=老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=neuro.Dr, createdTime=Mon Sep 20 17:43:45 CST 2021, time=2021-09-20, status=1, ipAttribution=)]
    2021-09-20 neuro.Dr

    老年性痴呆,未来还是希望借助神经电生理吧,也许更为有效!

    0

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