Orthostatic Hypotension linked to Dementia Risk In Individuals With or Without CV Conditions

Orthostatic hypotension (OH), a condition characterized by a sudden drop in blood pressure upon standing up, has been found to be associated with an increased risk of cardiovascular diseases (CVDs) and dementia. A recent study published in AHA Hypertension examined the associations of OH with CVD and subsequent dementia onset.

The study conducted by Xin Xia and team included 2,703 participants who were initially free of dementia and were divided into two cohorts: a CVD-free cohort (n=1,986) and a CVD cohort (n=717) consisting of individuals with pre-existing cardiovascular conditions. OH was defined as a decline in systolic/diastolic blood pressure of at least 20/10 mm Hg upon standing from a supine position. The occurrence of CVD and dementia was assessed by physicians or identified from registers. The associations of OH with CVD and subsequent dementia were analyzed using multistate Cox regressions.

● Orthostatic hypotension (OH) affected 434 individuals (21.9%) in the CVD-free cohort and 180 individuals (25.1%) in the CVD cohort.

● The presence of OH was associated with a hazard ratio of 1.33 (95% CI, 1.12–1.59) for developing CVD.

● However, when examining incident dementia in individuals without prior CVD, OH did not show a significant association (hazard ratio, 1.22 [95% CI, 0.83–1.81]).

● In the CVD cohort, individuals with OH had a higher risk of dementia compared to those without OH (hazard ratio, 1.54 [95% CI, 1.06–2.23]).

These findings suggest that the association between OH and dementia may be partially explained by the intermediate development of CVD. Additionally, in individuals with pre-existing CVD, the presence of OH may indicate a poorer cognitive prognosis.

Understanding the link between OH, CVD, and dementia is crucial for early identification and intervention. Further research is needed to explore the underlying mechanisms and potential therapeutic strategies to mitigate the impact of OH on dementia risk in individuals with CVD. Identifying and managing OH in clinical settings may help in preventing or delaying the onset of dementia in vulnerable populations.

This study sheds light on the importance of monitoring blood pressure changes upon standing, particularly in individuals with cardiovascular conditions, to identify those at higher risk for dementia. Early detection and appropriate management of OH may play a crucial role in mitigating the associated cognitive decline and improving patient outcomes.

Reference:

Xia, X., Qiu, C., Rizzuto, D., Fratiglioni, L., Dai, L., Laukka, E. J., Grande, G., & Vetrano, D. L. (2023). Role of orthostatic hypotension in the development of dementia in people with and without cardiovascular disease. Hypertension. https://doi.org/10.1161/HYPERTENSIONAHA.123.21210.