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Many people have had such an experience: standing up after squatting for a long time, immediately feeling dizzy and shaky...
Orthostatic hypotension (OH), also known as "orthostatic hypotension", is a phenomenon of abnormal drop in blood pressure after orthoped due to abnormal blood pressure regulation reflex, which can cause symptoms of cerebral insufficiency, such as dizziness, fatigue, blurred vision, pale, black haze, syncope, etc. Previous studies have shown that OH can lead to hypoperfusion in multiple organs, increasing the risk of adverse health outcomes such as cardiovascular disease (CVD), including ischaemic heart disease, atrial fibrillation, heart failure, and stroke (stroke). In addition, there are also studies that suggest that elevated OH may be associated with cognitive decline and increased risk of dementia, considering that CVD itself increases the risk of dementia, so the increased risk of dementia in OH patients can be attributed in part to the development of CVD, but there is a lack of relevant evidence.
Recently, Hypertension published a study showing that OH may increase the risk of dementia by increasing the risk of CVD (heart disease, stroke/transient ischemic attack) in older people. Among older people with heart disease, older people with OH may also have a worse prognosis than those without OH.
Image source: Hypertension
This was a 15-year population-based cohort study of 2703 participants without dementia, with a mean age of 73.7 years, which were included in the CVD-free group (1986 patients) and CVD group (717 patients), respectively, according to the presence or absence of CVD at baseline, with OH defined as a systolic/diastolic blood pressure decrease of ≥20/10 mmHg after changing from supine to standing.
The results showed that 21.9% (434/1986) and 25.1% (180/717) of participants in the CVD-free and CVD groups had OH, respectively. OH was significantly associated with the increased risk of CVD (HR=1.33, 95%CI=1.12~1.59), and not with the risk of dementia without previous CVD events (HR=1.22, 95%CI=0.83~1.81). History of OH was also associated with an increased risk of dementia in participants with CVD during follow-up, although this association was not statistically significant. OH was associated with an increased risk of heart disease (HR=1.32, 95%CI=1.07~1.63).
During the 6.6-year follow-up period, 171 of the 717 participants in the CVD group developed dementia. The risk of dementia in OH patients was significantly higher than that in non-OH patients (HR=1.54, 95% CI=1.06~2.23), and both non-neurogenic OH and neurogenic OH were associated with an increased risk of dementia, but only neurogenic OH was statistically significant in association with dementia.
Image source: Hypertension
Studies have shown that OH is common in older adults, which may be related to the increased risk of OH in certain diseases that older people are more susceptible to, such as cerebral volume depletion and neurodegenerative diseases. In older people without CVD, OH may be associated with an increased risk of future CVD and dementia, while a current or previous history of OH is associated with an increased risk of dementia in older people with CVD. Therefore, the intervention and management of OH in the elderly is very important. In addition, it also provides us with a new direction to think about, that OH may be considered as a predictor of CVD and Alzheimer's risk. For patients with OH, patient-centered and non-pharmacological approaches can be considered to reduce the risk of CVD and dementia in the elderly.
Overall, OH was associated with an increased risk of CVD in participants who were initially free of CVD, and OH was associated with an increased risk of dementia in patients with CVD. In the process of developing dementia in OH, CVD may play an important role.
Resources
[1] Xia X, Qiu C, Rizzuto D, et al. Role of Orthostatic Hypotension in the Development of Dementia in People With and Without Cardiovascular Disease. Hypertension. 2023 Jul;80(7):1474-1483. doi: 10.1161/HYPERTENSIONAHA.123.21210. Epub 2023 May 19. PMID: 37203439; PMCID: PMC10262990.
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