Longitudinal and postural changes of blood pressure predict dementia: the Malmö Preventive Project

Abstract

The role of blood pressure (BP) changes in dementia is debatable. We aimed to analyse how resting and postural BP changes relate to incident dementia over a long-term follow-up. In the prospective population-based Malmö Preventive Project, 18,240 study participants (mean age: 45 ± 7 years, 63% male) were examined between 1974 and 1992 with resting and standing BP measurement, and re-examined between 2002 and 2006 at mean age of 68 ± 6 years with resting BP. A total of 428 participants (2.3%) were diagnosed with dementia through Dec 31, 2009. The association of resting and postural BP changes with risk of dementia was studied using multivariable-adjusted Cox regression models controlling for traditional risk factors. Diastolic BP (DBP) decrease on standing indicated higher risk of dementia [Hazard ratio (HR) per 10 mmHg: 1.22; 95% confidence interval (CI) 1.01–1.44, p = 0.036], which was mainly driven by increased risk in normotensive individuals. Higher systolic (SBP) and diastolic BP at re-examination was associated with lower risk of dementia (HR per 10 mmHg: 0.94; 95% CI 0.89–0.99, p = 0.011; and 0.87; 0.78–0.96, p = 0.006, respectively). Extreme decrease in SBP/DBP between baseline and re-examination (4th quartile; −7 ± 12/−15 ± 7 mmHg, respectively) indicated higher risk of dementia (HR 1.46; 95% CI 1.11–1.93, p = 0.008, and 1.54; 95% CI 1.14–2.08, p = 0.005; respectively) compared with reference group characterised by pronounced BP increase over the same period (1st quartile; +44 ± 13/+15 ± 7 mmHg). Diastolic BP decrease on standing in the middle age, decline in BP between middle-and advanced age, and lower BP in advanced age are independent risk factors of developing dementia.Electronic supplementary materialThe online version of this article (doi:10.1007/s10654-017-0228-0) contains supplementary material, which is available to authorized users.

The association between orthostatic hypotension and dementia: A meta‐analysis of prospective cohort studies

“…Five prospective studies comprised 43 452 participants in total. According to their statistical methods (Cox proportional hazard model or logistic regression model), 4 studies sampled 41 972 participants using Cox proportional hazard model and 1 study used logistic regression model . Thus, 4 studies were analyzed quantitatively.…”

“…Among the 4 prospective studies included in meta‐analysis, 3 studies showed that people with OH had a significantly higher prevalence of dementia and 1 study demonstrated a negative result . When pooled, the results showed a positive overall effect.…”

“…Initially, literature search retrieved 279 articles, 5 of these articles met the inclusion criteria and 4 were included in the meta-analysis. [16][17][18][19][20] Among the 4 included studies, 1 study was published in the abstract form, but it provided most of information we wanted. 19 Based on the principle of comprehensive search, we included it in this meta-analysis.…”

“…20 Thus, 4 studies were analyzed quantitatively. [16][17][18][19] The mean or median of follow-up duration ranged from 6 to 28 years. Participants of all the included studies came from populations of good representativeness.…”

Orthostatic hypotension in patients with late‐life depression: Prevalence and validation of a new screening tool

“…Neurobiologically, it has been shown that this orthostatic stress could lead to cerebral hypo‐perfusion and subsequent formation of white matter hyperinsensities, a well known finding in late life depression (LLD). OH is also highly associated with syncope, falls, and overall increased mortality …”