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Role of Orthostatic Hypotension in the Development of Dementia in People with and Without Cardiovascular Disease

Xia, Xin LU ; Qiu, Chengxuan ; Rizzuto, Debora ; Fratiglioni, Laura ; Dai, Lu ; Laukka, Erika J. ; Grande, Giulia and Vetrano, Davide Liborio (2023) In Hypertension 80(7). p.1474-1483
Abstract

Background: Orthostatic hypotension (OH) has been associated with elevated risk of cardiovascular diseases (CVDs) and dementia risk. To better understand the OH-dementia association, we assessed the associations of OH with CVD and subsequent dementia in older adults and considered the temporality of CVD and dementia onset. Methods: This 15-year population-based cohort study included, at baseline, 2703 dementia-free participants (mean age, 73.7 years) who were divided into a CVD-free cohort (n=1986) and a CVD cohort (n=717). OH was defined as a systolic/diastolic blood pressure decline of ≥20/10 mm Hg after standing up from a supine position. CVDs and dementia were ascertained by physicians or identified from registers. Multistate Cox... (More)

Background: Orthostatic hypotension (OH) has been associated with elevated risk of cardiovascular diseases (CVDs) and dementia risk. To better understand the OH-dementia association, we assessed the associations of OH with CVD and subsequent dementia in older adults and considered the temporality of CVD and dementia onset. Methods: This 15-year population-based cohort study included, at baseline, 2703 dementia-free participants (mean age, 73.7 years) who were divided into a CVD-free cohort (n=1986) and a CVD cohort (n=717). OH was defined as a systolic/diastolic blood pressure decline of ≥20/10 mm Hg after standing up from a supine position. CVDs and dementia were ascertained by physicians or identified from registers. Multistate Cox regressions were applied to assess the associations of OH with CVD and subsequent dementia in the CVD-free and dementia-free cohort. The OH-dementia association in the CVD cohort was examined with Cox regressions. Results: OH was present in 434 (21.9%) individuals in the CVD-free cohort and 180 (25.1%) individuals in the CVD cohort. OH was associated with a hazard ratio of 1.33 (95% CI, 1.12-1.59) for CVD. OH was not significantly associated with incident dementia in the absence of CVD occurring before dementia diagnosis (hazard ratio, 1.22 [95% CI, 0.83-1.81]). In the CVD cohort, individuals with OH had a higher dementia risk than those without OH (hazard ratio, 1.54 [95% CI, 1.06-2.23]). Conclusions: The association between OH and dementia may partly be explained by the intermediate development of CVD. In addition, in people with CVD, those with OH may have a poorer cognitive prognosis.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiovascular diseases, cohort study, dementia, older adults, orthostatic hypotension
in
Hypertension
volume
80
issue
7
pages
10 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:37203439
  • scopus:85162789846
ISSN
0194-911X
DOI
10.1161/HYPERTENSIONAHA.123.21210
language
English
LU publication?
yes
id
97eebd25-231c-40c2-a2a0-4cf4011cba03
date added to LUP
2023-09-13 12:19:05
date last changed
2024-04-20 03:12:32
@article{97eebd25-231c-40c2-a2a0-4cf4011cba03,
  abstract     = {{<p>Background: Orthostatic hypotension (OH) has been associated with elevated risk of cardiovascular diseases (CVDs) and dementia risk. To better understand the OH-dementia association, we assessed the associations of OH with CVD and subsequent dementia in older adults and considered the temporality of CVD and dementia onset. Methods: This 15-year population-based cohort study included, at baseline, 2703 dementia-free participants (mean age, 73.7 years) who were divided into a CVD-free cohort (n=1986) and a CVD cohort (n=717). OH was defined as a systolic/diastolic blood pressure decline of ≥20/10 mm Hg after standing up from a supine position. CVDs and dementia were ascertained by physicians or identified from registers. Multistate Cox regressions were applied to assess the associations of OH with CVD and subsequent dementia in the CVD-free and dementia-free cohort. The OH-dementia association in the CVD cohort was examined with Cox regressions. Results: OH was present in 434 (21.9%) individuals in the CVD-free cohort and 180 (25.1%) individuals in the CVD cohort. OH was associated with a hazard ratio of 1.33 (95% CI, 1.12-1.59) for CVD. OH was not significantly associated with incident dementia in the absence of CVD occurring before dementia diagnosis (hazard ratio, 1.22 [95% CI, 0.83-1.81]). In the CVD cohort, individuals with OH had a higher dementia risk than those without OH (hazard ratio, 1.54 [95% CI, 1.06-2.23]). Conclusions: The association between OH and dementia may partly be explained by the intermediate development of CVD. In addition, in people with CVD, those with OH may have a poorer cognitive prognosis.</p>}},
  author       = {{Xia, Xin and Qiu, Chengxuan and Rizzuto, Debora and Fratiglioni, Laura and Dai, Lu and Laukka, Erika J. and Grande, Giulia and Vetrano, Davide Liborio}},
  issn         = {{0194-911X}},
  keywords     = {{cardiovascular diseases; cohort study; dementia; older adults; orthostatic hypotension}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1474--1483}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Hypertension}},
  title        = {{Role of Orthostatic Hypotension in the Development of Dementia in People with and Without Cardiovascular Disease}},
  url          = {{http://dx.doi.org/10.1161/HYPERTENSIONAHA.123.21210}},
  doi          = {{10.1161/HYPERTENSIONAHA.123.21210}},
  volume       = {{80}},
  year         = {{2023}},
}