Is Baseline Orthostatic Hypotension Associated With a Decline in Global Cognitive Performance at 4‐Year Follow‐Up? Data From TILDA (The Irish Longitudinal Study on Ageing)

Abstract

Background It is postulated that orthostatic hypotension ( OH ), a reduction in blood pressure (≥20/10 mm Hg) within 3 minutes of standing, may increase cognitive decline because of cerebral hypoperfusion. This study assesses the impact of OH on global cognition at 4‐year follow‐up, and the impact of age and hypertension on this association. Methods and Results Data from waves 1 and 3 of TILDA (The Irish Longitudinal Study on Ageing) were used. Baseline blood pressure response to active stand was assessed using beat‐to‐beat blood pressure monitoring. Two measures of OH were used—at 40 seconds ( OH 40) and 110 seconds ( OH 110). Global cognition was measured using the Montreal Cognitive Assessment. Mixed‐effects Poisson regression assessed whether baseline OH was associated with a decline in global cognition at 4‐year follow‐up. The analysis was repeated, stratifying by age (age 50–64 years and age ≥65 years), and including an interaction between OH and hypertension. Baseline OH 110 was associated with an increased error rate in Montreal Cognitive Assessment at follow‐up (incident rate ratio 1.17, P =0.028). On stratification by age, the association persists in ages 50 to 64 years (incident rate ratio 1.25, P =0.048), but not ages ≥65 years. Including an interaction with hypertension found those with co‐existent OH 110 and hypertension (incident rate ratio 1.27, P =0.011), or OH 40 and hypertension (incident rate ratio 1.18, P =0.017), showed an increased error rate; however, those with isolated OH 110, OH 40, or isolated hypertension did not. Conclusions OH is associated with a decline in global cognition at 4‐year follow‐up, and this association is dependent on age and co‐existent hypertension.

Orthostatic Blood Pressure Recovery Is Associated With the Rate of Cognitive Decline and Mortality in Clinical Alzheimer’s Disease

“…Our study, a substudy of the larger Nilvad trial, is limited by its small sample size, hampering the addition of relevant covariates such as hypertension ( 48 ). However, our study is enhanced, also compared with the larger Nilvad trial, by the detailed and thorough BP measurements and characterization of participants, including cerebral imaging.…”

Orthostatic hypotension as a risk factor for longitudinal deterioration of cognitive function in the elderly

“…The effect of OH on cognitive function remains contradictory in the literature depending on the age group, test battery (screening tool versus comprehensive multi-domain testing), covariates and study design. Several cross-sectional studies showed either no association with global cognitive function [3,10,11] or a significant association in terms of global cognitive decline [2,4,[12][13][14]. In a long-term analysis of the Rotterdam study, Wolters et al reported a higher risk of Alzheimer's disease and vascular dementia in participants with OH [15].…”

Orthostatic hypotension and cardiovascular events—Closing the link?

“…Orthostatic hypotension (OH), classically defined as a sustained drop of more than 20 mm Hg for systolic blood pressure (SBP) and/or more than 10 mm Hg for diastolic blood pressure (DBP) three minutes after standing upright or during a head-up tilt, 1,2 has been associated with an increased risk of cardiovascular disease. In fact, previous studies have reported a significant association of OH with cardiovascular morbidity and mortality, 3,4 atrial fibrillation, 5 cognitive decline, 6 among other clinical conditions. Being strongly associated with aging 7 and with the current demographic trends showing an increase in the proportion of the population above 65 years of age, the burden of OH is also expected to increase and contribute to a greater risk of falling, disability and reduced quality of life in the elderly.…”