From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; EA 4468 (J.-S.V., O.H.), Université Paris Descartes, Sorbonne Paris Cité; Service de gériatrie (J.-S.V., O.H.), Hôpital Broca, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Northern California Institute for Research and Education (T.H.), San Francisco; Unité INSERM 1027 (P.C.), Toulouse, France; and San Francisco VA Medical Center (K.Y.), CA.
Neurology. 2020 Oct 6;95(14):e1932-e1940. doi: 10.1212/WNL.0000000000010420. Epub 2020 Jul 20.
To determine whether orthostatic hypotension (OHYPO) and visit-to-visit blood pressure (BP) postural changes variability are associated with incident dementia.
We studied 2,131 older adults from the Health, Aging, and Body Composition cohort study. Orthostatic BP was repeatedly assessed over a 5-year baseline period. OHYPO was defined as a fall ≥15 mm Hg in systolic or ≥7 mm Hg in diastolic BP after standing from a sitting position for one-third or more of the visits. Systolic OHYPO and diastolic OHYPO were also examined separately. BP postural changes variability over time was evaluated with several indicators, including SD and coefficient of variation (CV). Incident dementia was determined over 12 years after the baseline period by dementia medication use, ≥1.5 SD decline in Modified Mini-Mental State Examination score, or hospitalization records.
Of 2,131 participants (mean age 73 years, 53% female, 39% Black), 309 (14.5%) had OHYPO, 192 (9.0%) had systolic OHYPO, 132 (6.2%) had diastolic OHYPO, and 462 (21.7%) developed dementia. After adjustment for demographics, seated systolic BP (SBP), antihypertensive drugs, cerebrovascular disease, diabetes mellitus, depressive symptoms, smoking, alcohol, body mass index, and presence of 1 or 2 ε4 alleles, systolic OHYPO was associated with greater dementia risk (adjusted hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.01-1.88), unlike diastolic OHYPO and OHYPO. SBP postural changes variability was also associated with higher dementia risk (highest tertile of variability [CV]: adjusted HR 1.35, 95% CI 1.06-1.71).
Systolic OHYPO and visit-to-visit SBP postural changes variability were associated with greater dementia risk. Our findings raise the question of potential preventive interventions to control orthostatic SBP and its fluctuations.
确定直立性低血压（OHYPO）和血压体位变化变异性与新发痴呆的关系。
我们研究了来自健康、衰老和身体成分队列研究的 2131 名老年人。在 5 年的基线期内，反复评估直立血压。OHYPO 的定义为从坐姿站立 1/3 或更多时间后收缩压下降≥15mmHg 或舒张压下降≥7mmHg。还分别检查了收缩期 OHYPO 和舒张期 OHYPO。通过几种指标评估了随时间推移的 BP 体位变化变异性，包括 SD 和变异系数（CV）。在基线期后 12 年内，通过痴呆药物使用、改良简易精神状态检查评分下降≥1.5SD 或住院记录确定新发痴呆。
在 2131 名参与者（平均年龄 73 岁，53%为女性，39%为黑人）中，309 名（14.5%）患有 OHYPO，192 名（9.0%）患有收缩期 OHYPO，132 名（6.2%）患有舒张期 OHYPO，462 名（21.7%）患有痴呆。在校正人口统计学、坐位收缩压（SBP）、抗高血压药物、脑血管疾病、糖尿病、抑郁症状、吸烟、饮酒、体重指数和 1 或 2 个 ε4 等位基因后，收缩期 OHYPO 与更大的痴呆风险相关（调整后的危险比 [HR]1.37，95%置信区间 [CI]1.01-1.88），而舒张期 OHYPO 和 OHYPO 则不然。SBP 体位变化变异性也与更高的痴呆风险相关（变异性最高三分位[CV]：调整后的 HR 为 1.35，95%置信区间为 1.06-1.71）。
收缩期 OHYPO 和 SBP 体位变化变异性与更高的痴呆风险相关。我们的发现提出了潜在的预防干预措施的问题，以控制直立性 SBP 及其波动。
