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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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WRAP-orthostatic-hypotension-symptomatic-subclinical-orthostatic-hypotension-Warwick-2018.pdf - Accepted Version - Requires a PDF viewer. Download (1138Kb) | Preview |
Official URL: http://dx.doi.org/10.1093/eurheartj/ehy418
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 | |||||||||
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| 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 |
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| 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: |
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| 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: |
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