| 马骏,张高宁,郭啸天,孟超,方宁远,凌圣婴.社区老年高血压患者体位性与餐后低血压及共病状态对认知功能下降的独立关联与交互作用的回顾性观察[J].老年医学与保健,2026,32(3):367-374 |
| 社区老年高血压患者体位性与餐后低血压及共病状态对认知功能下降的独立关联与交互作用的回顾性观察 |
| Retrospective observational study of independent association and interaction effects of orthostatic hypotension,postprandial hypotension and comorbidities on cognitive decline in community-dwelling elderly patients with hypertension |
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| DOI：10.3969/j.issn.1008-8296.2026.03.009 |
| 中文关键词: 高血压 社区 认知功能 多病共存 低血压 直立性 餐后低血压 |
| 英文关键词: hypertension community cognitive function comorbidities hypotension orthostatic postprandial hypotension |
| 基金项目::上海市医苑新星青年医学人才培养资助计划;PW2024D-09:上海市浦东新区卫生健康委员会联合攻关项目 |
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| 中文摘要: |
| 目的 探讨体位性低血压(OH)与餐后低血压(PPH)对社区老年高血压患者认知功能下降的独立影响、交互作用及剂量-反应关系.方法 对上海4 个社区的228 例60 岁及以上老年高血压患者开展回顾性观察研究,在既往项目留存的数据库中提取患者的社会人口学特征、行为、生活方式、疾病史与用药情况,通过简易精神状态检查量表评估认知功能并分为认知功能正常组、轻度认知功能障碍组和中重度认知功能障碍组3 组,采用卧立位试验和24 h 动态血压监测分别诊断 OH 和 PPH.采用有序多因素 Logistic 回归、限制性立方样条模型及交互作用分析进行统计评估.结果 OH(OR=3.55,P=0.005)与 PPH(OR=3.36,P=0.010)均增加了认知功能下降的发生风险,午餐后 PPH 与认知功能障碍的统计学关联最强(OR=8.95,P=0.002).体位性收缩压与舒张压下降幅度每增加1 mmHg,受试者认知功能处于更严重等级的风险独立上升 7%(P<0.05).交互作用分析提示,PPH 与共病数量存在显著负向交互(OR=0.63,P=0.037).剂量-反应分析进一步揭示,早餐和午餐后收缩压下降与认知下降的优势呈非线性关联,而体位性血压下降与认知风险呈线性正相关.结论 在社区老年高血压患者中,共病、OH 与 PPH 是与认知功能下降密切相关的独立且重要的临床因素,存在复杂的剂量-反应关系与交互作用. |
| 英文摘要: |
| Objective To investigate the independent effects,interaction effects,and dose-response relationships of orthostatic hypotension(OH)and postprandial hypotension(PPH)on cognitive decline in community-dwelling elderly patients with hypertension.Methods A retrospective observational study was conducted on 228 elderly hypertensive patients aged≥60 years from four communities in Shanghai.Their sociodemographic characteristics,behavioral and lifestyle factors,disease history,and medication use were extracted from existing project databases.Cognitive function was assessed using the mini-mental state examination.They were divided into three groups:normal group,mild impairment group,and moderate-to-severe impairment group.OH and PPH were diagnosed via the supine-to-standing test and 24-hour ambulatory blood pressure monitoring,respectively.Ordinal multivariate Logistic regression,restricted cubic spline models,and interaction analysis were used for statistical evaluation.Results Both OH(OR=3.55,P=0.005)and PPH(OR=3.36,P=0.010)independently increased the risk of cognitive decline.PPH after lunch exhibited the strongest statistical association with cognitive impairment(OR=8.95,P=0.002).For every 1 mmHg increased in the decline in postural systolic and diastolic blood pressure,the risk of the patients'cognitive function being at a more severe level increased independently by 7%(P<0.05).Interaction analysis indicated a significant negative interaction between PPH and the number of comorbidities(interaction term OR=0.63,P=0.037).Dose-response analysis further indicated a nonlinear association between post-breakfast and post-lunch systolic blood pressure decline and the risk of cognitive decline,while orthostatic blood pressure decline showed a linear positive association with cognitive risk.Conclusion In community-dwelling elderly hypertensive patients,comorbidities,OH and PPH are independent and significant clinical factors closely associated with cognitive decline,and there exists a complex dose-response relationship and interaction. |
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