맥압과 치매 발생 위험 간의 관련성 연구 : 국민건강보험공단 검진코호트자료를 이용하여

Abstract

Background: Current treatments for dementia have failed in proving consistency in slowing the progression of dementia, and further there are no known cure. Therefore, identifying risk factors of dementia has been a primary focus of much investigation. Pulse pressure, though a marker of arterial stiffness and an adequate independent predictor of cardiovascular disease, has been reevaluated in recent studies as a promising indicator of cognitive decline in elderly. This study examined the association between pulse pressure and the risk of dementia and evaluated its statistical significance. Methods: A retrospective cohort study with eligible subjects aged over 60 years and older with health examination records between 2004 and 2013. A total of 158,277 baseline population who had no record of dementia incidence at baseline and had available data for at least baseline measurements were included in the study. ICD-10 criteria were used to determine diagnostic records of dementia incident. Pulse pressure was calculated as the difference between systolic and diastolic blood pressure measures. Cox proportional hazard models were used to examine the association of pulse pressure measures with dementia incidents after adjustments for identified confounders including gender and age. Results: Among the study population, 8,610 subjects developed dementia accounting for 5.4% of the population. Pulse pressure was statistically significantly and positively associated with the higher risk of dementia (p<0.05). Categorical analysis was performed using pulse pressure as a categorical variable (PP<50*, 50-59, 60-69, 70-79, 80-89, >90) and found that subjects with the highest pulse pressure(>90) had relative risk of 1.28 (95% CI, 1.1 to 1.6) compared to the reference group, and this linear relationship was consistent with 50-59 (HR=1.1, 95% CI: 1.0 to 1.2) and 60-69 (HR=1.1, 95% CI: 1.0 to 1.2). Also, this relationship was evident in subgroup analysis with female, medical aid status and rural residence area. Regarding hypertension treatment, statistically significant and consistent relationship was found only to the subjects with no history of hypertension treatment, while no statistically meaningful relationship was noted in subjects with histories of hypertension treatment. Conclusions: Higher pulse pressure is associated with elevated risk of dementia in elderly aged over 60 years, and the subgroup analysis regarding hypertension treatment implicated an explanation supporting possible preventive effect on incident dementia among elderly undergoing hypertension treatments independent of the length of treatments.