Objective: To investigate the global cognitive function and the function of specific cognitive domains in hypertensive patients at high risk of cardiovascular disease in China, and to explore the impact of cognition function on blood pressure control. Methods: This is a cross-sectional survey. Data were obtained from the ESPRIT study. Patients with a history of hypertension who participated in the ESPRIT study from September 2019 to July 2020 were selected. Mini-mental state examination (MMSE) was used to evaluate patients' overall cognition and the function of each cognitive domain. According to the total MMSE score, patients were divided into the cognitive-intact group (MMSE total score=30 points), cognitive-declined group (MMSE total score<30 points, but did not reach the dementia screening threshold) and cognitive-impaired group (MMSE total score reached the dementia screening threshold). A multivariable logistic regression model was used to explore the effects of cognitive function and MMSE score on blood pressure control. The years of education were removed from the adjustment variables for sensitivity analysis. The interaction effect modeling of stratified variables and exposed variables was used for hierarchical analysis. Results: A total of 10 834 patients with hypertension at high risk of cardiovascular disease were enrolled, aged 65 (60, 69) years and 4 476 (41.3%) patients were female. There were 989 patients in cognitive-intact group, 8 676 patients in cognitive-declined group and 1 169 patients in cognitive-impaired group. The MMSE score of all included patients was (25.6±3.8) points. In the overall study population, 10.8% (1 169/10 834) of hypertensive patients had cognitive impairment, with an MMSE total score of (18.6±4.1) points. The cognitive domains with obvious impairment were recall memory (-80%), visuospatial function (-64%), attention and computation (-60%); 80.1% (8 676/10 834) of hypertensive patients did not meet the criteria for cognitive dysfunction, but had cognitive decline, and the cognitive domains with significant impairment were recall memory (-51%) and visuospatial structure (-23%). Multivariate logistic regression analysis showed that cognitive dysfunction (OR=0.88, 95%CI: 0.72-1.08, P=0.212) and cognitive decline (OR=0.96, 95%CI: 0.83-1.12,P=0.629) was not correlated with blood pressure control. MMSE total score and scores in each cognitive domain were not correlated with blood pressure control (P>0.05). Sensitivity analysis showed that cognitive function was not related to blood pressure control (all P>0.05). Stratified analysis according to different frequency of medication showed that cognitive function and MMSE score were not correlated with blood pressure control (P>0.05). Conclusion: One in ten hypertensive patients who were at high risk of cardiovascular disease have comorbid cognitive impairment. In patients with high risk of cardiovascular disease, the most affected cognitive domains were recall memory, visuospatial function, attention and calculation. Part of hypertensive patients have not reached the level of cognitive dysfunction, but have begun to show cognitive decline. Cognitive function is not an independent influencing factor on blood pressure control.
目的： 了解我国心血管疾病高危风险的高血压患者总体认知及各认知域功能情况，并探讨其对血压控制的影响。 方法： 该研究为横断面研究。研究数据来源于ESPRIT研究。入选2019年9月至2020年7月ESPRIT研究中有明确高血压病史的患者，应用简易精神状态检查表（MMSE）评价患者总体认知及各认知域功能，依据MMSE量表总评分将纳入患者分为认知功能完好组（MMSE总评分=30分）、认知功能下降组（MMSE总评分<30分，但尚未达到痴呆筛查界值）和认知功能障碍组（MMSE总评分达到痴呆筛查界值）。采用多因素logistic回归模型分析认知功能情况及MMSE评分对血压控制情况的影响。将教育年限从调整变量中剔除进行敏感性分析。采用分层变量和暴露变量的交互效应建模进行分层分析。 结果： 本研究共纳入10 834例具有心血管疾病高危风险的高血压患者，年龄65（60，69）岁，女性4 476例（41.3%）。认知功能完好组989例，认知功能下降组8 676例，认知功能障碍组1 169例。所有纳入患者的MMSE总评分为（25.6±3.8）分。总研究人群中，10.8%（1 169/10 834）的高血压患者合并认知功能障碍，MMSE总评分为（18.6±4.1）分，受损明显的认知域为回想记忆（-80%）、视空间结构（-64%）、注意力和计算能力（-60%）；80.1%（8 676/10 834）的高血压患者未达到认知功能障碍标准，但已有认知功能下降，受损明显的认知域为回想记忆（-51%）和视空间结构（-23%）。多因素logistic回归分析显示，认知功能障碍（OR=0.88，95%CI 0.72~1.08，P=0.212）及认知功能下降（OR=0.96，95%CI 0.83~1.12，P=0.629）与血压控制无关，MMSE总体认知评分及各认知域评分与血压控制也无关（P均>0.05）。敏感性分析结果显示认知功能情况与血压控制无关（P均>0.05）。根据不同用药频率进行分层分析，结果显示认知功能情况及MMSE评分与血压控制无关（P均>0.05）。 结论： 在心血管病高危风险高血压患者中，每10个人中就有1人合并认知功能障碍。心血管疾病高危风险的高血压患者认知功能受损主要体现在回想记忆、视空间结构、注意力和计算能力等认知域。部分患者虽然未达到认知功能障碍的程度，但已开始出现认知功能下降。认知功能并不是血压控制的独立影响因素。.