Relationship between orthostatic hypotension and poststroke cognitive impairment, acute myocardial infarction, and mortality in elderly patients with acute ischemic stroke: A retrospective observational study

Orthostatic hypotension (OH), a common autonomic disorder associated with transient cerebral hypoperfusion, has been linked to various neurological and cognitive impairments. However, its association with poststroke cognitive impairment (PSCI) in elderly patients remains unclear. This study investigates the association between OH and PSCI, as well as major cardiovascular outcomes - including acute myocardial infarction (AMI) and all-cause mortality - in elderly patients with acute ischemic stroke (AIS). We conducted a retrospective observational study involving 814 elderly patients (mean age: 70.8 ± 9.4 years; 68.7% female) with AIS admitted to a single-center between January 2018 and December 2021. OH was defined as a ≥ 20 mm Hg decrease in systolic blood pressure or ≥ 10 mm Hg decrease in diastolic blood pressure within 3 minutes of standing. Patients were classified into OH and non-OH groups. Clinical characteristics and 1-year outcomes, including recurrent stroke, AMI, and mortality, were analyzed. Among the 814 patients, 287 (35.3%) had OH. The OH group had significantly higher 1-year incidences of stroke, AMI, and all-cause mortality compared to the non-OH group (5.6% vs 3.8%, P = .006). The OH group also showed higher cumulative incidences of stroke (4.2% vs 2.5%, P = .011) and ischemic stroke (3.8% vs 1.9%, P = .027). Multivariate logistic regression identified PSCI (odds ratio [OR]: 4.677, 95% confidence interval [CI]: 2.133-10.255, P < .001) and age (OR: 1.927, 95% CI: 1.133-3.276, P = .015) as independent predictors of OH. Cox regression revealed that OH (hazard ratio [HR]: 2.971, 95% CI: 1.227-7.233, P = .016) and PSCI (HR: 2.312, 95% CI: 1.046-5.116, P = .039) were independently associated with recurrent stroke. OH is independently associated with increased risks of PSCI, recurrent stroke, AMI, and all-cause mortality in elderly AIS patients. Advanced age and cognitive impairment are important predictors of OH. These findings emphasize the clinical importance of evaluating orthostatic blood pressure changes and cognitive status in poststroke care.