血壓治療對年長者高血壓和認知功能障礙的影響

10.6666/ClinMed.2017.80.3.099

陳範宇；鄭浩民

高血壓 ； 中風 ； 認知功能 ； 降壓藥物

臨床醫學月刊

80卷3期（2017 / 09 / 29）

534 - 541

繁體中文

高血壓(arterial hypertension)和中風是造成認知功能障礙和失智症的重要危險因子。持續地血壓升高已被證實會影響認知功能。雖然認知功能障礙常發生於大中風或多次的小中風之後，但是在失智症眾多的表現型當中，最常見的是阿茲海默症(Alzheimer’s disease)和血管型失智症(vascular dementia)。這兩者的臨床表現類似也極難診斷。高血壓透過服用降壓藥物是屬於可改變的血管危險因子，不但可以減少中風的發生，也可能減緩認知功能的退化。然而，維持agerelated mental performance的理想血壓控制目標目前仍未被建立。在年老的高血壓患者使用至少一種類別的降壓藥物後，認知功能會有所改善。血管緊張素轉換酶抑製劑(ACEI)和鈣通道阻斷劑(CCB)更有著神經保護(neuroprotection)的效果。然而，由於J-曲線現象(J-curve phenomenon)，降低血壓可能會惡化大腦灌流並增加心血管疾病併發症的風險。有鑒於眾多隨機試驗結果的不確定性和矛盾，年長者的高血壓控制，特別是超過80歲的老人(octogenarian)，主要是根據專家建議。本篇文章主要回顧(1)高血壓和認知功能障礙間的關係(2)血壓控制的策略以及其對年長高血壓患者認知功能的好處。

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