10 Aug Orthostatic Hypotension Linked to Increased Dementia Risk
MedicalResearch.com Interview with:
Laure Rouch, PharmD PhD
Department of Psychiatry
Dr. Kristine Yaffe, MD (Senior Author)
Departments of Psychiatry, Neurology, and Epidemiology
University of California
San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
MedicalResearch.com: What is the background for this study?
Response: Worldwide, around 50 million people have dementia and this number is set to triple by 2050. Prevention of dementia and identification of potentially modifiable risk factors are, therefore, critically important. Postural changes in blood pressure increase with advancing age and affect 20% to 30% of older adults.
Yet it has not been explored deeply how orthostatic hypotension and blood pressure postural changes variability over time are associated with dementia risk. As multiple pharmacologic and nonpharmacologic interventions may improve orthostatic symptoms, this question has major public health implications.
MedicalResearch.com: What are the main findings?
Response: In older adults, systolic but not diastolic orthostatic hypotension increased dementia risk by approximately 40%, independently of cardiovascular comorbidities. We also found that patients whose systolic orthostatic blood pressure readings changed the most over time were more likely to develop dementia than those with more stable readings.
MedicalResearch.com: What should readers take away from your report?
Response: Our new study exploring the connection between vascular and brain health showed that systolic orthostatic hypotension and blood pressure postural changes variability over time could put older patients at higher risk for developing dementia. Most people think of dementia as one condition and vascular disease as a separate one when there is actually tremendous overlap and interplay between the two. From a clinical standpoint, monitoring as accurately as possible systolic orthostatic blood pressure and its long-term variability from a visit to another one is critically important in older adults. It may not only help identify patients at higher risk of cardiovascular events but also those who are more likely to develop dementia.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research should investigate whether controlling orthostatic blood pressure and its variability, including with an optimization of antihypertensive treatment, may be a therapeutic target to delay or prevent the onset of dementia.
Disclosures: Dr. Laure Rouch reports no disclosures relevant to this work. Dr. Kristine Yaffe serves on Data Safety Monitoring Board for Eli Lilly and several NIA-sponsored studies and is a member of the Beeson Scientific Advisory Board and the Global Council on Brain Health.
Citation: Systolic blood pressure postural changes variability is associated with greater dementia risk. Rouch L, Vidal JS, Hoang T, Cestac P, Hanon O, Yaffe K. Neurology. 2020 Jul doi: 10.1212/WNL.0000000000010420. Online ahead of print.https://n.neurology.org/content/early/2020/07/20/WNL.0000000000010420
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