Key result
SBP drop ≥20 mm Hg within 30 seconds of standing linked to ~22% higher dementia risk.
Why the study?
Abnormal orthostatic blood pressure regulation may cause cerebral hypoperfusion and contribute to dementia, but the relationship between the magnitude and timing of orthostatic responses and dementia risk remains incompletely understood.
Do early orthostatic blood pressure drops and dizziness increase the risk of developing dementia?
Cohort (n=11,644)
Yes
Do early orthostatic blood pressure drops and dizziness increase the risk of developing dementia?
Abrupt drops in systolic blood pressure within the first minute of standing are associated with a higher long-term risk of developing dementia.
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.
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Ma et al. (2023) conducted a cohort in Dementia risk (n=11,644). Decrease in systolic BP of ≤-20 mm Hg upon standing vs. Stable systolic BP (>-10 to 10 mm Hg) was evaluated on Adjudicated dementia (HR 1.22, 95% CI 1.01-1.47). A decrease in systolic blood pressure of ≤-20 mm Hg within 30 seconds of standing was associated with a higher risk of dementia compared to stable blood pressure (HR 1.22; 95% CI 1.01-1.47).
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