Center for Clinical and Epidemiological Research, University of São Paulo, Brazil.
Division of Geriatrics, University of São Paulo Medical School, Brazil.
J Gerontol A Biol Sci Med Sci. 2019 Feb 15;74(3):358-365. doi: 10.1093/gerona/gly061.
The association between orthostatic hypotension (OH) and cognitive impairment is controversial, and most studies have investigated older white adults from Western Europe and the United States. Therefore, we investigated the association between OH and cognitive performance in a large and racially diverse sample of adults using cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
OH was defined when systolic blood pressure decreased 20 mmHg and/or diastolic blood pressure decreased 10 mmHg from supine to standing position. We investigated the association between OH and composite global cognition, memory, verbal fluency (VF), and Trail Making Test z-scores, using multiple linear regression models. We also investigated the association of orthostatic hypertension and systolic blood pressure/diastolic blood pressure changes with cognitive performance, as well as the interaction between OH and compensatory heart rate after postural change on cognitive performance.
We evaluated 12,826 participants (mean age = 51.5 ± 9.0 years, 46% male, 53% white). Participants with OH (4% of the sample) had poorer z-scores for VF (β = -0.108, 95% confidence interval = -0.189; -0.025, p = .01) than participants without OH. Orthostatic hypertension was also associated with worse performance on the VF test (β = -0.080, 95% confidence interval = -0.157; -0.003, p = .04). Systolic blood pressure orthostatic change had a nonlinear association with VF. The interaction terms between OH and compensatory increase in heart rate for the Trail Making Test z-score (p = .09) was borderline significant, suggesting that participants who lack compensatory heart rate after postural change might have poorer performance.
OH and orthostatic hypertension were associated with poorer performance on the VF test in participants from Brazil.
直立性低血压（OH）与认知障碍之间的关联存在争议，大多数研究都调查了来自西欧和美国的老年白种成年人。因此，我们使用巴西成年人健康纵向研究（ELSA-Brasil）的横断面数据，在一个大型的、种族多样化的成年人样本中调查了 OH 与认知表现之间的关系。
当收缩压从卧位下降 20mmHg 和/或舒张压从卧位下降 10mmHg 时，定义为 OH。我们使用多元线性回归模型调查了 OH 与复合总体认知、记忆、言语流畅性（VF）和 Trail Making 测试 z 评分之间的关系。我们还调查了直立性高血压和收缩压/舒张压变化与认知表现的关系，以及 OH 和体位变化后代偿性心率变化对认知表现的交互作用。
我们评估了 12826 名参与者（平均年龄 51.5±9.0 岁，46%为男性，53%为白人）。OH 患者（占样本的 4%）的 VF z 评分较差（β=-0.108，95%置信区间为-0.189；-0.025，p=0.01）。直立性高血压也与 VF 测试表现较差相关（β=-0.080，95%置信区间为-0.157；-0.003，p=0.04）。收缩压直立性变化与 VF 呈非线性关系。OH 与体位变化后代偿性心率增加之间的交互项对 Trail Making 测试 z 评分有边缘显著意义（p=0.09），这表明体位变化后缺乏代偿性心率的参与者可能表现较差。
OH 和直立性高血压与巴西参与者的 VF 测试表现较差相关。
