Orthostatic Blood Pressure Change, Dizziness, and Risk of Dementia in the ARIC Study

Author:

Ma Yuan1ORCID,Zhang Yiwen1ORCID,Coresh Josef2ORCID,Viswanathan Anand3ORCID,Sullivan Kevin J.4ORCID,Walker Keenan A.5ORCID,Liu Chelsea1,Lipsitz Lewis A.6,Selvin Elizabeth2ORCID,Sharrett A. Richey2ORCID,Gottesman Rebecca F.7ORCID,Blacker Deborah18ORCID,Hofman Albert1ORCID,Windham B. Gwen4,Juraschek Stephen P.9ORCID

Affiliation:

1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Y.M., Y.Z., C.L., D.B., A.H.).

2. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C., E.S., A.R.S.).

3. Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (AV).

4. Memory Impairment and Neurogenerative Dementia Center, University of Mississippi Medical Center, Jackson (K.J.S., B.G.W.).

5. Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD (K.A.W.).

6. Beth Israel Deaconess Medical Center, Harvard Medical School, and Hebrew Senior Life Hinda and Arthur Marcus Institute for Aging Research, Boston (L.A.L.).

7. National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD (R.F.G.).

8. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (D.B.).

9. Division of General Medicine, Beth Israel Deaconess Medical Center, Boston (S.P.J.).

Abstract

BACKGROUND: Abnormal orthostatic blood pressure (BP) regulation may result in cerebral hypoperfusion and brain ischemia and contribute to dementia. It may also manifest as early symptoms of the neurodegenerative process associated with dementia. The relationship between the magnitude and timing of orthostatic BP responses and dementia risk is not fully understood. METHODS: We conducted a prospective cohort analysis of the associations of orthostatic BP changes and self-reported orthostatic dizziness with the risk of dementia in the Atherosclerosis Risk in Communities study (ARIC). We calculated changes in BP from the supine to the standing position at 5 measurements taken within 2 minutes after standing during the baseline visit (1987–1989). The primary outcome was adjudicated dementia ascertained through 2019. RESULTS: Among 11 644 participants (mean [SD] age, 54.5 [5.7] years; 54.1% women; 25.9% Black), 2303 dementia cases were identified during a median follow-up of 25.9 years. Large decreases in systolic BP from the supine to standing position measured at the first 2 measurements ≈30 and 50 seconds after standing, but not afterward, were associated with orthostatic dizziness and a higher risk of dementia. Comparing a decrease in systolic BP of ≤−20 or >−20 to −10 mm Hg to stable systolic BP (>−10 to 10 mm Hg) at the first measurement, the adjusted hazard ratios were 1.22 (95% CI, 1.01–1.47) and 1.10 (95% CI, 0.97–1.25), respectively. CONCLUSIONS: Abnormal orthostatic BP regulation, especially abrupt drops in BP within the first minute, might be early risk markers for the development of dementia. Transient early orthostatic hypotension warrants more attention in clinical settings.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Internal Medicine

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