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Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment : an integrated evidence review and analysis of a large older adult hypertensive cohort

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Peters, Ruth, Anstey, Kaarin J., Booth, Andrew, Beckett, Nigel, Warwick, Jane, Antikainen, Riitta, Rockwood, Kenneth, Peters, Jean and Bulpitt, Christopher J. (2018) Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment : an integrated evidence review and analysis of a large older adult hypertensive cohort. European Heart Journal , 39 (33). pp. 3135-3143. doi:10.1093/eurheartj/ehy418

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Official URL: http://dx.doi.org/10.1093/eurheartj/ehy418

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Abstract

Aims

Systematically reviewing the literature found Orthostatic Hypotension (OH) to be associated with an increased risk of incident dementia but limited data were available in those at highest risk, the hypertensive oldest-old. Our aim was to analyse the relationship between OH and incident cognitive decline or dementia in this group and to synthesize the evidence base overall.

Method and results

Participants aged≥ 80 years, with hypertension, were from the Hypertension in the Very Elderly Trial (HYVET) cohort. OH was defined as a fall of >=15mmHg in systolic and or >=7mmHg in diastolic pressure after two minutes standing from a sitting position. Subclinical orthostatic fall with symptoms (SOH) was defined as a fall<OH but with unsteadiness, light-headedness or faintness in the week before blood pressure measurement. Proportional hazard regression was used to examine the relationship between baseline OH, SOH and cognitive outcomes. There were 3121 in the analytical sample, 538 with OH. OH was associated with increased risk of cognitive decline (906 events) Hazard Ratio(HR)1.36 (95%Confidence Interval 1.14:1.59). For incident dementia (241 events) HR1.34(0.98:1.84). When competing risk of cardiovascular events were taken into account results were HR1.39(1.19:1.62) and HR1.34 (1.05:1.73) respectively. SOH was associated with an increased risk of cognitive decline HR1.56(1.12:2.17) and dementia HR1.79(1.00:3.20).

Combining the results from the HYVET cohort in a meta-analysis with the existing published literature in this area found a 21%(9%:35%) increased risk of dementia with OH.

Conclusion

OH indicates an increased risk of dementia and cognitive decline. SOH may also be considered a risk factor, at least in older hypertensive adults. Questions remain regarding the mechanisms and whether interventions to reduce impact of OH could protect cognition.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Hypotension, Orthostatic, Dementia, Older people -- Health and hygiene
Journal or Publication Title: European Heart Journal
Publisher: Oxford University Press
ISSN: 1522-9645
Official Date: 1 September 2018
Dates:
DateEvent
1 September 2018Published
24 July 2018Available
21 July 2018Accepted
Date of first compliant deposit: 30 November 2018
Volume: 39
Number: 33
Page Range: pp. 3135-3143
DOI: 10.1093/eurheartj/ehy418
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDBritish Heart Foundationhttp://dx.doi.org/10.13039/501100000274
UNSPECIFIEDServierUNSPECIFIED

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