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RESEARCH PRODUCT

Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study.

Giuseppe SergiS ZambonStefania MaggiEstella MusacchioEgle PerissinottoNicola VeroneseEnzo ManzatoMaria Chiara CortiLeonardo SartoriChiara CurreriValter GiantinG. CrepaldiCaterina Trevisan

subject

Malemedicine.medical_specialtyAgingPostureDiastoleBlood Pressure030204 cardiovascular system & hematologyNeuropsychological TestselderlyRisk AssessmentNOorthostatic hypotension03 medical and health sciencesOrthostatic vital signsHypotension Orthostatic0302 clinical medicineCognitionInternal medicinemedicineInternal MedicinePrevalenceHumansCognitive DysfunctionCognitive declinecognitive impairmentAgedorthostatic hypertensionPsychiatric Status Rating Scalesbusiness.industryConfoundingBlood Pressure DeterminationOdds ratioPrognosisBlood pressureItalyCohortHypertensionCardiologyPhysical therapyFemaleblood pressure; cognition; cognitive impairment; elderly; orthostatic hypertension; orthostatic hypotension; Internal MedicineOrthostatic hypertensionmedicine.symptombusinessCognition Disorders030217 neurology & neurosurgery

description

We studied a cohort of 1408 older subjects to explore whether postural changes in blood pressure (BP; defined as orthostatic hypo- or hypertension) can predict the onset of cognitive deterioration. Orthostatic hypotension was defined as a drop of 20 mm Hg in systolic or 10 mm Hg in diastolic BP and orthostatic hypertension as a rise of 20 mm Hg in systolic BP. Orthostatic BP values were grouped into quintiles for secondary analyses. Two cognitive assessments were considered: (1) cognitive impairment, that is, Mini-Mental State Examination scores ≤24/30, and (2) cognitive decline (CD), that is, a 3-point decrease in Mini-Mental State Examination score from the baseline to the follow-up. At the baseline, the prevalence of orthostatic hypotension and hypertension was 18.3% and 10.9%, respectively. At the follow-up (4.4±1.2 years), 286 participants were found cognitively impaired and 138 had a CD. Using logistic regression analysis adjusted for potential baseline confounders, participants with orthostatic hypertension were at significantly higher risk of CD (odds ratio =1.50; 95% confidence intervals =1.26-1.78). Neither orthostatic hypotension nor orthostatic hypertension raised the risk of developing a cognitive impairment. Using quintiles of orthostatic BP values, we found that both decreases and increases in systolic and diastolic BP raised the risk of CD, but not of cognitive impairment. In conclusion, we found that orthostatic hypertension predicts the onset of CD, but not of cognitive impairment in the elderly, whereas orthostatic hypotension predicts neither of these conditions. Further studies are needed to confirm our findings. © 2016 American Heart Association, Inc.

10.1161/hypertensionaha.116.07334https://pubmed.ncbi.nlm.nih.gov/27324223