Influencing factors of cognitive impairment in patients with hypertension: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHAO Ziran ¹ , YANG Xiaoli ¹ , GUO Honghua ¹ , XIA Yan ¹ , LI Wen ² , TAN Chunmiao ³ ,  ZHANG Caihong ¹

1. School of International Nursing, Hainan Medical University, Haikou 571199, P. R. China;
2. Nursing Homes in Hainan Province, Haikou 570100, P. R. China;
3. Department of Geriatrics, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, P. R. China;

Corresponding author：

ZHANG Caihong, Email: 404669792@qq.com

Keywords：

Hypertension; Cognitive impairment; Influencing factors; Meta-analysis

DOI：

10.7507/1672-2531.202307129

Video：

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Objective To systematically review the factors for cognitive impairment in hypertensive patients. Methods PubMed, Web of Science, Embase, Cochrane Library, Ovid, Scopus, EBSCO, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies on factors for cognitive impairment in hypertensive patients from inception to March 2023. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 and Stata 14.0 software. Results A total of 26 articles involving 13 464 patients were included. The results of meta-analysis showed that antihypertensive drug use (OR=0.22, 95%CI 0.09 to 0.59, P=0.002), blood pressure was well controlled (OR=0.48, 95%CI 0.37 to 0.623, P<0.001), and social support (OR=0.94, 95%CI 0.90 to 0.97, P<0.001) were protective factors for CI in hypertensive patients. And age (OR=1.17, 95%CI 1.12 to 1.22, P<0.001), age ≥60 (OR=2.10, 95%CI 1.71 to 2.57, P<0.001), female (OR=1.55, 95%CI 1.25 to 1.93, P<0.001), single (OR=2.39, 95%CI 1.89 to 3.03, P<0.001), smoking (OR=3.40, 95%CI 2.40 to 4.82, P < 0.001), educational level (<college） (OR=3.46, 95%CI 2.73 to 4.39, P<0.001), education years (≥12 years) (OR=2.10, 95%CI 1.43 to 3.07, P<0.001), diabetes (OR=2.82, 95%CI 2.22 to 3.58, P<0.001), hyperlipidemia (OR=1.48, 95%CI 1.10 to 2.00, P=0.01), total cholesterol (OR=1.11, 95%CI 1.01 to 1.22, P=0.02), CVHI anomalies (OR=6.24, 95%CI 3.75 to 10.37, P<0.001), sleep disorder (OR=2.92, 95%CI 1.93 to 4.42, P<0.001), systolic blood pressure (OR=1.04, 95%CI 1.02 to 1.06, P<0.001), orthostatic hypotension (OR=1.39, 95%CI 1.20 to 1.62, P<0.001, grade 2 hypertension (OR=2.62,95%CI 1.83 to 3.73, P<0.001), grade 3 hypertension (OR=3.15, 95%CI 1.90 to 5.22, P<0.001), stress history (OR=4.57, 95%CI 2.86 to 7.30, P<0.001) were all risk factors. Conclusion The current evidence shows that there are many factors affecting the incidence of CI in hypertensive patients, and the assessment of the factors affecting the incidence of cognitive dysfunction in hypertensive patients should be more comprehensive in the future.

Citation： ZHAO Ziran, YANG Xiaoli, GUO Honghua, XIA Yan, LI Wen, TAN Chunmiao, ZHANG Caihong. Influencing factors of cognitive impairment in patients with hypertension: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2024, 24(5): 577-583. doi: 10.7507/1672-2531.202307129 Copy

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1. 李苏宁, 陈祚, 王增武, 等. 我国老年人高血压现状分析. 中华高血压杂志, 2019, 27(2): 140-148.
2. Qin J, He Z, Wu L, et al. Prevalence of mild cognitive impairment in patients with hypertension: a systematic review and meta-analysis. Hypertens Res, 2021, 44(10): 1251-1260.
3. Jia L, Du Y, Chu L, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study. Lancet Public Health, 2020, 5(12): 661-671.
4. 胡亦新, 郭艺芳, 王磊. 老年高血压合并认知障碍诊疗中国专家共识(2021版). 中华高血压杂志, 2021, 29(4): 311-322.
5. Santisteban MM, Iadecola C, Carnevale D. Hypertension, neurovascular dysfunction, and cognitive impairment. Hypertension, 2023, 80(1): 22-34.
6. Ungvari Z, Toth P, Tarantini S, et al. Hypertension-induced cognitive impairment: from pathophysiology to public health. Nat Rev Nephrol, 2021, 17(10): 639-654.
7. Castilla-Guerra L. Late-life hypertension as a risk factor for cognitive decline and dementia. Hypertens Res, 2022, 45(10): 1670-1671.
8. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
9. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
10. 赵丽洁, 武宏, 霍秀红. 高血压患者海马体积和脑血管反应性与认知功能减退的相关性. 中华高血压杂志, 2021, 29(6): 562-566.
11. 尉鑫慧. 基于血压变异性的老年高血压患者认知功能减退风险预测. 呼和浩特: 内蒙古医科大学, 2021.
12. 傅卫红, 谢柏梅, 张彦海, 等. 军队离退休老年高血压患者认知功能障碍的危险因素. 中华高血压杂志, 2014, 22(6): 559-563.
13. 金鑫. 老年高血压患者认知功能与微量白蛋白尿的关系. 石家庄: 河北医科大学, 2010.
14. 李晗. 老年高血压患者认知功能障碍的临床特点及其相关因素研究. 太原: 山西医科大学, 2021.
15. 刘泽源. 老年高血压患者认知功能障碍的影响因素及相关分析. 长春: 吉林大学, 2021.
16. 何志兰. 老年高血压患者睡眠质量对认知功能障碍的影响. 合肥: 安徽医科大学, 2020.
17. 周波, 汪芳军, 金庞, 等. 原发性高血压患者认知功能障碍与血清Klotho蛋白浓度的关联. 中华高血压杂志, 2020, 28(4): 374-377.
18. Zhuo X, Huang M, Wu M. Analysis of cognitive dysfunction and its risk factors in patients with hypertension. Medicine (Baltimore), 2022, 101(10): e28934.
19. Yamamoto K, Akasaka H, Yasunobe Y, et al. Clinical characteristics of older adults with hypertension and unrecognized cognitive impairment. Hypertens Res, 2022, 45(4): 612-619.
20. Peters R, Anstey KJ, Booth A, et al. Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort. Eur Heart J, 2018, 39(33): 3135-3143.
21. 马万瑞, 李漫娜, 王立群, 等. ≥55岁高血压患者发生轻度认知功能障碍的影响因素研究. 中国全科医学, 2023, 26(9): 1075-1079,1085.
22. 叶青芳, 王旖旎, 李玲, 等. 中青年高血压住院患者轻度认知功能障碍发生现状及影响因素研究. 中国全科医学, 2023, 26(2): 154-159,167.
23. 陈玲, 杨连招, 陆静钰, 等. 南宁市社区老年高血压患者轻度认知障碍现状及影响因素研究. 中华护理教育, 2022, 19(6): 566-571.
24. 秦虹云, 诸秉根, 王玲, 等. 新发和不治疗高血压对社区轻度认知功能障碍老年人认知功能影响的随访调查. 中国全科医学, 2020, 23(13): 1640-1646,1653.
25. 陆静钰. 社区老年高血压患者轻度认知功能障碍影响因素及风险预测模型构建. 南宁: 广西中医药大学, 2021.
26. 谢玉芳, 杨凤, 黄小红, 等. 老年高血压患者合并脑血管血流动力学异常对轻度认知功能障碍的影响. 中国现代医生, 2021, 59(32): 117-120.
27. 宋彦丽, 林杰, 夏文静, 等. 同型半胱氨酸与高血压患者轻度认知障碍的相关性. 中国卒中杂志, 2020, 15(12): 1322-1326.
28. 葛婷爱, 周逸丹, 王赛英, 等. 老年高血压患者合并脑血管血流动力学异常对轻度认知功能障碍的影响. 中华高血压杂志, 2018, 26(6): 582-585.
29. 余科, 祁风, 刘祖佑, 等. 高血压患者轻度认知功能障碍与大脑中动脉狭窄的关系及危险因素. 中华全科医学, 2017, 15(4): 614-616.
30. Yan X, Meng T, Liu H, et al. The association between the duration, treatment, control of hypertension and lifestyle risk factors in middle-aged and elderly patients with mild cognitive impairment: a case-control study. Neuropsychiatr Dis Treat, 2022, 18: 585-595.
31. Ma L, Feng M, Qian Y, et al. Insulin resistance is an important risk factor for cognitive impairment in elderly patients with primary hypertension. Yonsei Med J, 2015, 56(1): 89-94.
32. Wu L, He Y, Jiang B, et al. The association between the prevalence, treatment and control of hypertension and the risk of mild cognitive impairment in an elderly urban population in China. Hypertens Res, 2016, 39(5): 367-375.
33. Solfrizzi V, Scafato E, Frisardi V, et al. Angiotensin-converting enzyme inhibitors and incidence of mild cognitive impairment. The Italian longitudinal study on aging. Age (Dordr), 2013, 35(2): 441-453.
34. 李倩, 赵建华, 彭雪, 等. H型高血压患者血尿酸水平与轻度认知功能障碍的相关性分析. 中国全科医学, 2021, 24(20): 2527-2531.
35. Pallangyo P, Mkojera ZS, Komba M, et al. Burden and correlates of cognitive impairment among hypertensive patients in Tanzania: a cross-sectional study. BMC Neurol, 2021, 21(1): 433.
36. Wei J, Yin X, Liu Q, et al. Association between hypertension and cognitive function: a cross-sectional study in people over 45 years old in China. J Clin Hypertens (Greenwich), 2018, 20(11): 1575-1583.
37. Hou Q, Guan Y, Liu X, et al. Development and validation of a risk model for cognitive impairment in the older Chinese inpatients: an analysis based on a 5-year database. J Clin Neurosci, 2022, 104: 29-33.
38. Corley E, Fahey L, Fitzgerald J, et al. The impact of early adversity and education on genetic and brain morphological predictors of cognitive ability. Genes Brain Behav, 2023, 22(4): e12850.
39. Miyawaki CE, Liu M. Gender differences in cognitive impairment among the old and the oldest-old in China. Geriatr Gerontol Int, 2019, 19(7): 586-592.
40. Oremus M, Konnert C, Law J, et al. Social support and cognitive function in middle- and older-aged adults: descriptive analysis of CLSA tracking data. Eur J Public Health, 2019, 29(6): 1084-1089.
41. Magrin ME, D'Addario M, Greco A, et al. Social support and adherence to treatment in hypertensive patients: a meta-analysis. Ann Behav Med, 2015, 49(3): 307-318.
42. Gardener H, Levin B, DeRosa J, et al. Social connectivity is related to mild cognitive impairment and dementia. J Alzheimers Dis, 2021, 84(4): 1811-1820.
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