Study on the relationship between hypertension and its comorbidities and dementia in community dwelling older adults in China

Abstract

Background: China is experiencing an accelerated aging process, with an increasing number of elderly individuals suffering from chronic diseases. The association between hypertension, its comorbidities, and dementia in the elderly requires further investigation.

Objective: To explore the prevalence of hypertension and its comorbidities in community dwelling older adults and their correlation with dementia, providing a reference for dementia prevention.

Methods: This study utilized cross-sectional data from the 2018-2023 China Multicenter Dementia Survey (CMDS), which included demographic, chronic disease, and cognitive function assessments of 14,732 elderly individuals aged 65 and above. A multivariate logistic regression model was applied to analyze the correlation between hypertension, its comorbidities, and dementia.

Results: Among the 14,732 elderly participants, 8,293 (56.3 %) had two or more comorbidities, and 7,786 (52.9 %) had hypertension with comorbidities. Of these, 2,569 (17.4 %) had one comorbidity, 2,064 (14.0 %) had two, 1,018 (6.9 %) had three, and 443 (3.0 %) had four. Dementia was present in 1,111 (7.5 %) participants. After adjusting for confounding factors, multivariate logistic regression revealed that the risk of dementia in individuals with hypertension was 1.516 times higher (95 % CI: 1.014-2.267) compared to those without hypertension. The risks of dementia for individuals with 1-4 comorbidities were 1.879 times (95 % CI: 1.312-2.692), 2.071 times (95 % CI: 1.428-3.004), 2.338 times (95 % CI: 1.612-3.392), and 2.591 times (95 % CI: 1.634-4.108), respectively. The highest risk (2.550 times, 95 % CI: 1.384-4.700) was observed in those with hypertension and cerebrovascular dementia. Stratified by gender and age, dementia risk increased significantly with the number of comorbidities, with statistical significance (P<0.05). The highest risks for males and females with hypertension and cerebrovascular dementia were 2.842 (95 % CI: 1.095-7.375) and 2.348 (95 % CI: 1.060-5.203), respectively. For individuals aged under 75 years, the highest risk was associated with hypertension and diabetes (OR=2.833, 95 % CI: 1.046-7.675), while for those aged 75 and above, hypertension combined with cerebrovascular disease showed the highest risk (OR=2.707, 95 % CI: 1.168-6.273). Among individuals with two comorbidities, hypertension with heart disease and cerebrovascular disease had the highest dementia prevalence (OR=3.559, 95 % CI: 1.338-9.468). In those with three comorbidities, hypertension combined with heart disease, cerebrovascular disease, and autonomic dysfunction had the highest dementia prevalence (OR=3.881, 95 % CI: 1.736-8.677).

Conclusion: The prevalence of hypertension and its comorbidities is high among the elderly in China, and the risk of dementia is significantly increased in those with hypertension and its comorbidities. This risk shows variations based on age and gender.

Keywords

Hypertension / Dementia / Comorbidities / Odds ratio / Elderly people

Declarations

Not applicable.

Authors' contributions

Conceptualization, N.Q.; Methodology, N.Q. and C.G.; Data curation, S.D. and L.J.; Formal analysis, N.Q.; Funding acquisition, X.L.; Project administration, C.G.; Resources, C.G.; Supervision, X.L.; Validation, Z.L.; Writing—original draft, N.Q.; Writing—review and editing,N.Q. and C.G. All authors have read and agreed to the published version of the manuscript.

Ethical approval and consent to participate

The study received approval from Tianjin Huanhu Hospital Ethics Committee (No.201940).

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

This work was supported by funding awarded to L.X. grants from National Natural Science Foundation of China (Project number: 72174159).

Authors' other information

Not applicable.

Declaration of competing interest

All authors declare that there are no competing interests.

Acknowledgements

The authors express their gratitude to the CMDS research and field team and the study participants for their valuable contributions to this research.

References

[1] 2023 Alzheimer’s disease facts and figures. Alzheimer’s Dementia. 2023; 19(4):1598-1695. doi: 10.1002/alz.13016.

[2] Nichols E, Steinmetz JD, Vollset SE, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022; 7(2):e105-e125. doi: 10.1016/S2468-2667(21)00249-8.

[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):e661-e671. doi: 10.1016/S2468-2667(20)30185-7.

[4] Passeri E, Elkhoury K, Morsink M, et al. Alzheimer’s disease: treatment strategies and their limitations. Int J Mol Sci. 2022; 23(22):13954. doi: 10.3390/ijms232213954.

[5] Badji A, Youwakim J, Cooper A, et al. Vascular cognitive impairment - past, present, and future challenges. Ageing Res Rev. 2023. doi: 10.1016/j.arr.2023.102042.

[6] Scheltens P, De Strooper B, Kivipelto M, et al. Alzheimer’s disease. Lancet. 2021; 397(10284):1577-1590. doi: 10.1016/S0140-6736(20)32205-4.

[7] Rasmussen IJ, Thomassen JQ, Frikke-Schmidt R. Impact of metabolic dysfunction on cognition in humans. Nutr Metab. 2020; 32(1).

[8] Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024; 404(10452):572-628. doi: 10.1016/S0140-6736(24)01296-0.

[9] Hu FF, Cheng GR, Liu D, et al. Population-attributable fractions of risk factors for all-cause dementia in China rural and urban areas: a cross-sectional study. J Neurol. 2022; 269(6):3147-3158. doi: 10.1007/s00415-021-10886-y.

[10] Fabbri M, Beracci A, Martoni M, et al. Measuring subjective sleep quality: a review. Int J Environ Res Public Health. 2021; 18(3):1082. doi: 10.3390/ijerph18031082.

[11] Greco C, Di Gennaro F, D’Amato C, et al. Validation of the composite autonomic symptom Score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes. Diabet Med. 2017; 34(6):834-838. doi: 10.1111/dme.13310.

[12] Zhang ZY, Ma YJ, Fu LJ, et al. Diagnostic value of composite autonomic symptom Score 31 in diabetic cardiovascular autonomic neuropathy. (Chinese). Chin Clin Med. 2020; 27(2):229-234. doi: 10.12025/j.issn.1008-6358.2020.20191956.

[13] Guo QH, Hong Z. Neuropsychological assessment. (Chinese). Shanghai: Shanghai Scientific & Technical Publishers; 2016.

[14] Lane CA, Hardy J, Schott JM. Alzheimer’s disease. (Chinese). Eur J Neurol. 2018; 25(1):59-70. doi: 10.1111/ene.13439.

[15] Katz S, Downs TD, Cash HR, et al. Progress in development of the Index of ADL. Gerontologist. 1970; 10(1 Part1):20-30. doi: 10.1093/geront/10.1_Part_1.20.

[16] Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004; 256(3):183-194. doi: 10.1111/j.1365-2796.2004.01388.x.

[17] Chinese Dementia and Cognitive Impairment Diagnosis and Treatment Guidelines Writing GroupNeurology physician branch of chinese medical doctor association, cognitive impairment disease specialty committee. 2018 china dementia and cognitive impairment diagnosis and treatment guidelines (V): diagnosis and treatment of mild cognitive impairment. Nation Med J China. 2018; 98(17):1294-1301. doi: 10.3760/cma.j.issn.0376-2491.

[18] Chinese Dementia and Cognitive Impairment Guidelines Writing GroupNeurology physician branch of chinese medical doctor association, cognitive impairment disease specialty committee. 2018 China dementia and cognitive impairment diagnosis and treatment guidelines (I): dementia and its classification diagnosis criteria. Nation Med J China. 2018; 98(13):965-970. doi: 10.3760/cma.j.issn.0376-2491.2018.13.003.

[19] Dao RA, Tian Y, Chen H, et al. Incidence and influencing factors of subacute and chronic pain in postoperative ICU patients. Med J Pek Union Med College Hospital. 2024; 15(3):598-603. doi: 10.12290/xhyzz.2023-0580.

[20] Li YN, Wang YQ. Study on the status and patterns of comorbidity in elderly people with chronic diseases in China. Chin Gen Pract. 2021; 24(31):3955-3962 + 3978. doi: 10.12114/j.issn.1007-9572.2021.00.295.

[21] Wang MJ, Zhou X, Li YJ, et al. Meta-analysis of the prevalence of chronic disease comorbidity in middle-aged and elderly people in China from 2010 to 2019. Chin Gen Pract. 2021; 24(16):2085-2091. doi: 10.12114/j.issn.1007-9572.2020.00.477.

[22] Zhang YL, Huang XY, Qi BY, et al. Current challenges and strategies for addressing comorbidity in the elderly population. Chin Gen Pract. 2022; 25(35):4363-4368. doi: 10.12114/j.issn.1007-9572.2022.0514.

[23] Yang X, Yang X, Yang JY, et al. The impact of sleep disorders on cognitive function in rural elderly people in Guizhou Province, China. Chin J Public Health. 2021; 37(8):1233-1236. doi: 10.11847/zgggws1127829.

[24] Han LZ. Clinical Study On the Current Status and Related Factors of Insomnia in the Elderly [dissertation]. (Chinese). Shanghai: Shanghai Jiao Tong University; 2020.

[25] Zhang RX, Zhang SD, Qi H, et al. Influencing factors of sleep disorders in the elderly and their effects on immune status, cognitive function, and quality of life. Mod Biomed Progress. 2022; 22(21):4071-4075. doi: 10.13241/j.cnki.pmb.2022.21.012.

[26] Tully PJ, Hanon O, Cosh S, et al. Diuretic antihypertensive drugs and incident dementia risk: a systematic review, meta-analysis and meta-regression of prospective studies. J Hypertens. 2016; 34(6):1027-1035. doi: 10.1097/HJH.0000000000000868.

[27] Ding J, KL Davis-PLOURDE, Sedaghat S, et al. Antihypertensive medications and risk for incident dementia and Alzheimer’s disease: a meta-analysis of individual participant data from prospective cohort studies. Lancet Neurol. 2020; 19(1):61-70. doi: 10.1016/S1474-4422(19)30393-X.

[28] McGrath ER, Beiser AS, DeCarli C, et al. Blood pressure from mid-to late life and risk of incident dementia. Neurology. 2017; 89(24):2447-2454. doi: 10.1212/WNL.0000000000004741.

[29] Cannistraro RJ, Badi M, Eidelman BH, et al. CNS small vessel disease: a clinical review. Neurology. 2019; 92(24):1146-1156. doi: 10.1212/WNL.0000000000007654.

[30] Moretti R, Caruso P. Small vessel disease-related dementia: an invalid neurovascular coupling? Int J Mol Sci. 2020; 21(3):1095. doi: 10.3390/ijms21031095.

[31] Zhao X, Xu X, Yan Y, et al. Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic. Lancet Region Health - West Pacific. 2024; 51:101198. doi: 10.1016/j.lanwpc.2024.101198.

[32] Akushevich I, Yashkin A, Ukraintseva S, et al. The construction of a multidomain risk model of Alzheimer’s disease and related dementias. J Alzheimers Dis. 2023; 96(2):535-550. doi: 10.3233/JAD-221292.

[33] Hainsworth AH, Markus HS, Schneider JA. Cerebral small vessel disease, hypertension, and vascular contributions to cognitive impairment and dementia. Hypertension. 2024; 81(1):75-86. doi: 10.1161/HYPERTENSIONAHA.123.19943.

[34] YL YANG, ZENG Y, XU L, et al. The influence of insomnia and its types on cognitive disorders in the elderly. (Chinese). Chin J Public Health. 2023; 39(6):734-739. doi: 10.11847/zgggws1140402.

[35] Arvanitakis Z, Capuano AW, Lamar M, et al. Late-life blood pressure association with cerebrovascular and Alzheimer disease pathology. Neurology. 2018; 91:e517-e525. doi: 10.1212/WNL.0000000000005951.

[36] Levine DA, Springer MV, Brodtmann A. Blood pressure and vascular cognitive impairment. Stroke. 2022; 53(4):1104-1113. doi: 10.1161/STROKEAHA.121.036140.

[37] Oveisgharan S, Kim N, Agrawal S, et al. Brain and spinal cord arteriolosclerosis and its associations with cerebrovascular disease risk factors in community-dwelling older adults. Acta Neuropathol. 2023; 145(2):219-233. doi: 10.1007/s00401-022-02527-z.