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It remains unclear whether lowering the blood pressure effectively prevents cognitive impairment. The aim of the current study was to explore the association between the prevalence, treatment and control of hypertension and the risk of mild cognitive impairment MCI among elderly Chinese people.
This is a cross-sectional study conducted leei Beijing, China.
The Mini-Mental State Examination was used to assess participants’ cognitive function. The prevalence of MCI was higher in hypertensive Furthermore, in those hypertensive patients, the prevalence of MCI was lower in those treated However, among the treated hypertensive patients, there was no difference in eem prevalence e MCI between the patients who reached and those who did not reach their treatment goal. We suggest that improved diagnoses and optimal therapeutics are needed to achieve the aim of cognitive decline prevention.
With the anticipated increase in the elderly population, a higher prevalence of hypertension is emerging.
In recent years, accumulating epidemiologic and mechanistic evidence has shown that hypertension is also an important risk factor for dementia, Alzheimer’s disease and mild cognitive impairment MCI. Byadults over 60 years of age will constitute Moreover, an optimal treatment approach must be developed to prevent the expected social and disease burden.
The current study aims to examine the association between the prevalence, treatment and control of hypertension and the increased risk of MCI in participants over 60 years of age in an urban area lek Beijing, China.
The sampling method was described in our previous study. First, we randomly selected 9 of the 94 eem in the Wanshoulu District. Second, we selected all the households only one elderly resident from each household was recruited with elderly residents from these 9 communities. Between September and Junea total of of the elderly subjects completed the survey, resulting in a response rate of After excluding 97 adults with incomplete data, a total of subjects males and females were included lri the current survey.
EC approved the current study. Signed informed consent was obtained from all of the eligible participants. Each participant completed a 982 questionnaire through a face-to-face interview. Data were collected on the participants’ demographic characteristics, medical histories and lifestyles. Trained observers measured the body height, weight, waist circumference and blood pressure of each participant according 19999 the standardized protocol.
While participants were in the standing position, their waist circumference was measured midway between the lower rib margin and the iliac crest. The body height was measured in meters while participants were not wearing shoes. The body mass index was calculated as weight in kilograms divided by height in meters squared. After an overnight fasting, blood specimens were obtained for the measurements of serum lipids and glucose.
Trained neurologists evaluated each participant’s cognitive function with the Mini-Mental State Examination MMSEwhich is a commonly used measurement worldwide. Before the survey, each participant was asked to avoid drinking alcohol, smoking cigarettes and drinking coffee or tea.
Each participant’s blood pressure records were obtained from to hours. Both diastolic blood pressure and systolic blood pressure were measured twice with a resting interval between the two measurements.
The mean of the two readings was calculated to record each participant’s blood pressure value. Trained observers calculated the average of the three records as the final measurement. The data were double entered using Epidata 3. The relationship between the prevalence, treatment and control of hypertension and the MMSE score continuous variable was examined using a multivariable linear regression model.
The baseline characteristics of the participants are shown in Table 1. The data for a total of males and females participants were included in the analysis. The mean age of the participants was The male participants were significantly older, were taller and had greater weight, higher waist circumference, lower systolic blood pressure, higher diastolic blood pressure, lower total cholesterol, lower triglycerides, lower high-density lipoprotein-cholesterol, lower low-density lipoprotein-cholesterol and higher MMSE scores than the female participants.
The proportions of male participants who were better educated, married, normotensive and currently drinking and smoking were significantly higher than those of the female participants. Overall, the mean MMSE score was In the hypertensive patient population, the rates of hypertension treatment and control were A rate of hypertension control of The prevalence of MCI showed little difference between males The prevalence of hypertension in female participants The analysis of the population of treated hypertensive patients revealed that the hypertension control rate in male participants A higher proportion of females Table 2 shows the unadjusted and adjusted association between the prevalence, treatment and control of hypertension and the MMSE score by gender.
There was no significant difference in the MMSE score between the hypertensive patients who received treatment for hypertension and achieved or did not achieve the treatment goal. Both male and female participants showed trends that were similar to those obtained in the main analyses. Table 3 shows the unadjusted and adjusted associations between the prevalence, treatment and control of dde and the prevalence of MCI by gender.
Overall, the prevalence of MCI was higher in hypertensive However, the difference between the treated hypertensive patients who achieved and those who did not achieve their treatment goal was not significant.
Both male and female participants showed trends that were similar to those obtained in the main analyses, but the differences were e, significant in females.
Table 4 shows the unadjusted and adjusted associations between the prevalence, treatment and control of hypertension and the prevalence of MCI by age.
Overall, participants in all age groups showed trends that were similar to those of the general population. The present study is a population-based, cross-sectional study with a strict training process and quality assurance programs. After adjusting for confounding variables, we found that the prevalence of hypertension was positively associated with the prevalence of MCI, whereas the treatment of hypertension was negatively related li the prevalence of MCI, particularly in males and the younger elderly population in an urban community in Beijing, China.
Previous studies on the cognitive consequences of hypertension among the elderly population have yielded inconsistent results. Both positive and negative relationships have been reported between hypertension and cognition decline.
A cross-sectional study by Paran et al. It should be noted that the the participants in the reports mentioned above was older than the participants in the present study. The possible biological mechanism linking blood pressure and cognitive decline has been explored by Skoog, 27 who found that age-related changes in the brain might oei to low blood pressure in very old people. However, for the Nonetheless, the findings of the current study are in accordance with previous authors who have reported a positive relationship between hypertension and cognitive decline.
For the prevalence of MCI, both male and female participants showed trends that were similar to those of the general population, but the differences were not significant in females. To the best of our knowledge, no previous studies have separately studied men and women.
Further prospective cohort studies with larger samples should be conducted to explore possible explanation for potential gender differences. Whether lowering blood pressure aids in preventing dementia or cognitive decline in hypertensive patients is unclear.
In a meta-analysis, Chang-Quan et al. The conclusion of Chang-Quan et al. The findings of the current study were in line with some randomized controlled trials. A 4-year follow-up study by Tzourio et al. It is worth noting that the two ORs ORs for the prevalence of MCI in treated hypertensive patients compared with all untreated hypertensive patients and in patients with controlled hypertensive compared with those with non-controlled hypertension regardless of treatment obtained throughout the main analyses were similar.
In addition, the differences in the MMSE score and the prevalence of MCI were not significant between treated hypertensive patients who reached and those who did not reach their treatment goal in the present study.
The results suggest that treatment for hypertension by itself appears to exert a protective effect against MCI, but the results show that the aims of controlled and uncontrolled hypertension have almost no impact on the prevalence of MCI.
Admittedly, the present study was limited by its small sample size; thus, a larger sample size is required to detect the association between hypertension control and the prevalence of MCI among treated hypertensive patients in future research.
Furthermore, numerous complex factors may be involved in the evaluation of higher blood pressure and poorer cognitive performance.
Long-term hypertension might be associated with brain white matter diseases, resulting in cognitive impairment. As the most important risk factor for stroke, hypertension substantially increases the risk of cognitive impairment. Admittedly, this study has some limitations. First, cross-sectional studies are limited in determining the direction of an association, as both the exposure and the outcome are simultaneously assessed. lri
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Second, the information lifestyles and disease histories about each participant was self-reported, which might result in recall bias. To avoid these issues, we asked all the participants to bring their certificate of disease diagnosis to the interview, if possible. Third, detailed information on the wm diets and types of antihypertensive drugs used was not collected; such factors might be important covariates in the analysis of the study. Fourth, the association between hypertension and cognitive function is multifactorial, and the elderly population often has many risk factors, such as atherosclerosis, cardiovascular disease and diabetes mellitus.
Although we have adjusted the potential confounding variables in the analysis, other undetected covariates might affect the results of the current study. This possible issue may have had a critical influence on the cross-sectional relationship of interest. Sixth, misclassification bias may exist in the present study. Emm of the treated hypertensive patients may have not taken antihypertensive medication in the morning of the day of the study because the study participants were asked to undergo this examination without having eaten breakfast that day.
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This may have led to the misclassification of some of the patients with controlled hypertension as patients with uncontrolled hypertension due to an increase in blood pressure on the day of study. Finally, the Wanshoulu Community is a metropolitan area that is representative of the geographic and economic characteristics of Beijing, but the results are likely difficult to generalize to other areas in China. Further prospective studies with larger sample sizes are required to examine the association between the prevalence, awareness and treatment of hypertension and cognitive performance in the elderly population in China.
In conclusion, the present study showed a positive relationship between the prevalence of hypertension, untreated hypertension and an increased risk of cognitive impairment, particularly in males and the younger elderly population in an urban community of Beijing.
The question of whether treatment for hypertension reached or did not reach the treatment goal to have an impact on the prevalence of MCI is an important topic to be addressed with a larger sample size in future research. Our findings suggest that improved diagnoses and optimal therapeutics are needed to achieve the target of cognitive decline prevention in the elderly population. YH and BJ helped design the study and analyzed the data.
BJ and JW helped with the data collection and field operations. All of the authors helped prepare the manuscript.