Neuroscience Research Australia (NeuRA), Barker Street, Randwick, Australia.
School of Psychology, University of New South Wales, Sydney, Australia.
Eur Heart J. 2018 Sep 1;39(33):3135-3143. doi: 10.1093/eurheartj/ehy418.
Systematically reviewing the literature found orthostatic hypotension (OH) to be associated with an increased risk of incident dementia but limited data were available in those at highest risk, the hypertensive oldest-old. Our aim was to analyse the relationship between OH and incident cognitive decline or dementia in this group and to synthesize the evidence base overall.
Participants aged ≥80 years, with hypertension, were from the Hypertension in the Very Elderly Trial (HYVET) cohort. Orthostatic hypotension was defined as a fall of ≥15 mmHg in systolic and or ≥7 mmHg in diastolic pressure after 2 min standing from a sitting position. Subclinical orthostatic hypotension with symptoms (SOH) was defined as a fall <OH but with unsteadiness, light-headedness, or faintness in the week before blood pressure measurement. Proportional hazard regression was used to examine the relationship between baseline OH, SOH, and cognitive outcomes. There were 3121 in the analytical sample, 538 with OH. Orthostatic hypotension was associated with increased risk of cognitive decline (906 events), hazard ratio (HR) 1.36 (95% confidence interval 1.14-1.59). For incident dementia (241 events), HR 1.34 (0.98-1.84). When competing risk of cardiovascular events were taken into account results were HR 1.39 (1.19-1.62) and HR 1.34 (1.05-1.73), respectively. Subclinical orthostatic hypotension was associated with an increased risk of cognitive decline HR 1.56 (1.12-2.17) and dementia HR 1.79 (1.00-3.20). Combining the results from the HYVET cohort in a meta-analysis with the existing published literature in this area found a 21% (9-35%) increased risk of dementia with OH.
Orthostatic hypotension indicates an increased risk of dementia and cognitive decline. SOH may also be considered a risk factor, at least in older hypertensive adults. Questions remain regarding the mechanisms and whether interventions to reduce impact of OH could protect cognition.
系统回顾文献发现，体位性低血压（OH）与痴呆症发病风险增加相关，但在高血压高龄人群这一最高危人群中，相关数据有限。我们的目的是分析 OH 与该人群认知能力下降或痴呆症发病的关系，并综合整体证据基础。
参与者年龄≥80 岁，患有高血压，来自高血压老年人试验（HYVET）队列。体位性低血压定义为从坐姿站立 2 分钟后收缩压下降≥15mmHg 和/或舒张压下降≥7mmHg。伴有症状的亚临床体位性低血压（SOH）定义为下降<OH，但在血压测量前一周出现不稳定、头晕或昏厥。比例风险回归用于检查基线 OH、SOH 与认知结果之间的关系。分析样本中共有 3121 人，538 人存在 OH。OH 与认知能力下降（906 例事件）的风险增加相关，风险比（HR）为 1.36（95%置信区间为 1.14-1.59）。对于新发痴呆症（241 例事件），HR 为 1.34（0.98-1.84）。当考虑到心血管事件的竞争风险时，结果分别为 HR 1.39（1.19-1.62）和 HR 1.34（1.05-1.73）。亚临床体位性低血压与认知能力下降的风险增加相关（HR 1.56[1.12-2.17]）和痴呆症（HR 1.79[1.00-3.20]）。将 HYVET 队列的结果与该领域已发表文献的荟萃分析相结合，发现 OH 使痴呆风险增加 21%（9-35%）。
体位性低血压表明痴呆症和认知能力下降的风险增加。SOH 也可能被视为危险因素，至少在老年高血压患者中如此。关于机制以及是否干预降低 OH 影响可以保护认知的问题仍然存在。
