Systolic orthostatic hypotension (OHYPO) and variability in visit-to-visit systolic blood pressure (BP) postural changes may be associated with increased risk of dementia, according to study results published in Neurology.

BP postural changes affects a significant percent of the elderly population, and various pharmacologic/non-pharmacologic interventions may improve orthostatic symptoms. Additionally, while previous studies have indicated the association between OHYPO and cardiovascular outcomes, much less is understood about the relationship of OHYPO with cognitive ones. Study researchers consequently sought to evaluate whether OHYPO and variability in visit-to-visit BP postural changes were associated with dementia.

The study included older adults (mean age, 73 years; 53% women) who were pooled from the Health, Aging, Body Composition cohort study (n=2131). In this cohort, changes in orthostatic BP were assessed at baseline and at 1, 3, and 5 years. Patients were considered to have OHYPO if they experienced a decrease of at least 15 mmHg in systolic or at least 7 mmHg in diastolic BP after standing from a sitting position for a minimum of 1 out of 3 clinic visits. Both systolic and diastolic OHYPO were assessed separately.

Variability in BP postural changes were also examined over time. Additionally, the investigators examined the prevalence of incident dementia over a 12-year period after baseline (total follow up, 17 years) by assessing dementia medication use, changes in Modified Mini-Mental State (≥1.5 standard deviation decline), or records of hospitalization with dementia.


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A total of 309 (14.5%) patients had OHYPO, 192 (9.0%) had systolic OHYPO, 132 (6.2%) had diastolic OHYPO, and 462 (21.7%) developed incident dementia over 12 years. Systolic OHYPO correlated with greater dementia risk in a multivariable adjusted analysis (adjusted hazard ratio [HR], 1.37; 95% CI, 1.01-1.88). No significant association was found between diastolic OHYPO and increased risk of dementia (adjusted HR, 0.92; 95% CI, 0.60-1.40). Variability in systolic BP postural changes also correlated with an increased risk of dementia, particularly in the highest tertile of variability (adjusted HR, 1.35; 95% CI, 1.06-1.71).

Limitations of this study included its observational design, the lack of a formal and structured clinical assessment for dementia, and the reliance on a relatively small number of orthostatic BP measures to assess variability in BP postural changes.

The study researchers concluded that the management of “orthostatic systolic BP and its variability, including with an optimization of antihypertensive treatment, could be a promising interventional target in preserving cognitive function among older adults.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Rouch L, Vidal JS, Hoang T, Cestac P, Hanon O, Yaffe K. Systolic blood pressure postural changes variability is associated with greater dementia risk. Neurology. Published online July 20, 2020. doi:10.1212/WNL.0000000000010420