当前位置:科学网首页 > 小柯机器人 >详情
药物降压可显著降低痴呆或认知障碍的风险
作者:小柯机器人 发布时间:2020/5/20 21:11:52

爱尔兰努加韦和萨奥尔塔大学医院集团Michelle Canavan研究团队取得一项新突破。他们对血压降低与痴呆或认知障碍风险的相关性进行了分析。该研究于2020年5月19日发表于《美国医学会杂志》。

降低血压对预防痴呆或认知障碍的益处尚不清楚。

为了确定血压降低与痴呆或认知障碍的关系,研究组在PubMed、EMBASE和CENTRAL等数据库中检索从建库到2019年12月31日发表的文章,筛选出评估血压降低与认知结局关联的随机临床试验,并进行荟萃分析。

共有14项随机临床试验符合入选条件,包含96158名参与者。其中12项报告了随访期痴呆并被纳入主要荟萃分析,8项报告了认知功能下降,8项报告了认知测试分数改变。试验参与者的平均年龄为69岁,女性占42.2%。平均收缩压基线为154 mm Hg,平均舒张压为83.3 mm Hg。

平均随访49.2个月后,使用降压药降压组患者发生痴呆或认知障碍的风险为7.0%,显著低于对照组(7.5%);认知能力下降的风险为20.2%,显著低于对照组(21.1%)。血压降低与认知测验分数的变化没有显著相关性。

综上,使用降压药降低血压可显著降低痴呆或认知障碍的风险。

附:英文原文

Title: Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta-analysis

Author: Diarmaid Hughes, Conor Judge, Robert Murphy, Elaine Loughlin, Maria Costello, William Whiteley, Jackie Bosch, Martin J. O’Donnell, Michelle Canavan

Issue&Volume: 2020/05/19

Abstract: Importance  The benefit of blood pressure lowering for the prevention of dementia or cognitive impairment is unclear.

Objective  To determine the association of blood pressure lowering with dementia or cognitive impairment.

Data Sources and Study Selection  Search of PubMed, EMBASE, and CENTRAL for randomized clinical trials published from database inception through December 31, 2019, that evaluated the association of blood pressure lowering on cognitive outcomes. The control groups consisted of either placebo, alternative antihypertensive agents, or higher blood pressure targets.

Data Extraction and Synthesis  Data were screened and extracted independently by 2 authors. Random-effects meta-analysis models were used to report pooled treatment effects and CIs.

Main Outcomes and Measures  The primary outcome was dementia or cognitive impairment. The secondary outcomes were cognitive decline and changes in cognitive test scores.

Results  Fourteen randomized clinical trials were eligible for inclusion (96 158 participants), of which 12 reported the incidence of dementia (or composite of dementia and cognitive impairment [3 trials]) on follow-up and were included in the primary meta-analysis, 8 reported cognitive decline, and 8 reported changes in cognitive test scores. The mean (SD) age of trial participants was 69 (5.4) years and 40 617 (42.2%) were women. The mean systolic baseline blood pressure was 154 (14.9) mm Hg and the mean diastolic blood pressure was 83.3 (9.9) mm Hg. The mean duration of follow-up was 49.2 months. Blood pressure lowering with antihypertensive agents compared with control was significantly associated with a reduced risk of dementia or cognitive impairment (12 trials; 92135 participants) (7.0% vs 7.5% of patients over a mean trial follow-up of 4.1 years; odds ratio [OR], 0.93 [95% CI, 0.88-0.98]; absolute risk reduction, 0.39% [95% CI, 0.09%-0.68%]; I2=0.0%) and cognitive decline (8 trials) (20.2% vs 21.1% of participants over a mean trial follow-up of 4.1 years; OR, 0.93 [95% CI, 0.88-0.99]; absolute risk reduction, 0.71% [95% CI, 0.19%-1.2%]; I2=36.1%). Blood pressure lowering was not significantly associated with a change in cognitive test scores.

Conclusions and Relevance  In this meta-analysis of randomized clinical trials, blood pressure lowering with antihypertensive agents compared with control was significantly associated with a lower risk of incident dementia or cognitive impairment.

DOI: 10.1001/jama.2020.4249

Source: https://jamanetwork.com/journals/jama/article-abstract/2766163

期刊信息

JAMA-Journal of The American Medical Association:《美国医学会杂志》,创刊于1883年。隶属于美国医学协会,最新IF:51.273
官方网址:https://jamanetwork.com/
投稿链接:http://manuscripts.jama.com/cgi-bin/main.plex