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Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline.

TitleAssociation of orthostatic hypotension with incident dementia, stroke, and cognitive decline.
Publication TypeJournal Article
Year of Publication2018
AuthorsRawlings AM, Juraschek SP, Heiss G, Hughes T, Meyer ML, Selvin E, Sharrett ARichey, B Windham G
Secondary AuthorsGottesman RF
Date Published2018 08 21
KeywordsArteriosclerosis, Blood Pressure, Cognition Disorders, Cohort Studies, Dementia, Female, Humans, Hypotension, Orthostatic, Incidence, Male, Middle Aged, Neuropsychological Tests, Outcome Assessment, Health Care, Residence Characteristics, Stroke

OBJECTIVE: To examine associations of orthostatic hypotension (OH) with dementia and long-term cognitive decline and to update previously published results in the same cohort for stroke with an additional 16 years of follow-up.

METHODS: We analyzed data from 11,709 participants without a history of coronary heart disease or stroke who attended the baseline examination (1987-1989) of the prospective Atherosclerosis Risk in Communities (ARIC) study. OH was defined as a drop in systolic blood pressure (BP) of at least 20 mm Hg or a drop in diastolic BP of at least 10 mm Hg on standing. Dementia was ascertained via examination, contact with participants or their proxy, or medical record surveillance. Ischemic stroke was ascertained via cohort surveillance of hospitalizations, cohort follow-up, and linkage with registries. Both outcomes were adjudicated. Cognitive function was ascertained via 3 neuropsychological tests administered in 1990 to 1992 and 1996 to 1998 and a full battery of tests in 2011 to 2013. Scores were summarized and reported as SDs. We used adjusted Cox regression and linear mixed models.

RESULTS: Over ≈25 years, 1,068 participants developed dementia and 842 had an ischemic stroke. Compared to persons without OH at baseline, those with OH had a higher risk of dementia (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.20-1.97) and ischemic stroke (HR 2.08, 95% CI 1.65-2.62). Persons with OH had greater, although nonsignificant, cognitive decline over 20 years (SD 0.09, 95% CI -0.02 to 0.21).

CONCLUSIONS: OH assessed in midlife was independently associated with incident dementia and ischemic stroke. Additional studies are needed to elucidate potential mechanisms for these associations and possible applications for prevention.

Alternate JournalNeurology
PubMed ID30045960
PubMed Central IDPMC6107267
Grant ListU01 HL096812 / HL / NHLBI NIH HHS / United States
P50 AG005146 / AG / NIA NIH HHS / United States
U01 HL096917 / HL / NHLBI NIH HHS / United States
R01 DK089174 / DK / NIDDK NIH HHS / United States
U01 HL096902 / HL / NHLBI NIH HHS / United States
U01 HL096814 / HL / NHLBI NIH HHS / United States
U01 HL096899 / HL / NHLBI NIH HHS / United States
K23 HL135273 / HL / NHLBI NIH HHS / United States
K24 AG052573 / AG / NIA NIH HHS / United States