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Dizziness upon standing associated with higher risk for dementia, stroke
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Middle-aged adults who experience a sudden drop in BP when standing up, known as orthostatic hypotension, may have a greater risk for dementia or having an ischemic stroke, according to research published in Neurology.
“Orthostatic hypotension has been linked to heart disease, fainting and falls, so we wanted to conduct a large study to determine if this form of low blood pressure was also linked to problems in the brain, specifically dementia,” Andreea M. Rawlings, PhD, MS, from Johns Hopkins Bloomberg School of Public Health, said in a press release.
Rawlings and colleagues enrolled 11,709 adults (average age, 54 years) without a history of coronary heart disease or stroke at baseline in the study. Participants completed up to five follow-up visits over an average of 25 years.
During the first visit, participants were screened for orthostatic hypotension through a test in which their BP was taken five times after they stood up in a smooth, swift motion following 20 minutes of laying down. Low BP upon standing was defined as a decline of at least 20 mm Hg in systolic BP or at least 10 mm Hg in diastolic BP. Participants with orthostatic hypotension may feel faint, dizzy or lightheaded upon standing. Normal BP was defined as less than 120/80 mm Hg. Roughly 5% of patients had orthostatic hypotension at baseline.
The researchers reviewed participants’ medical records to monitor for dementia and stroke. They identified 1,068 participants who had developed dementia and 842 who had an ischemic stroke.
Results indicated that participants with orthostatic hypotension at the beginning of the study were 54% more likely to develop dementia than those who did not. Approximately 13% of patients with orthostatic hypotension developed dementia compared with 9% patients without orthostatic hypotension.
Additionally, the risk of ischemic stroke was doubled among patients with orthostatic hypotension. About 15% of patients with orthostatic hypotension had an ischemic stroke compared with 6.8% of those without the condition.
Bleeding strokes was not associated with orthostatic hypotension.
“Measuring orthostatic hypotension in middle age may be a new way to identify people who need to be carefully monitored for dementia or stroke,” Rawlings said. “More studies are needed to clarify what may be causing these links as well as to investigate possible prevention strategies.” – by Alaina Tedesco
Disclosure: Rawlings reports receiving support from the NIH/NHLBI. Please see study for all other authors’ relevant financial disclosures.
Perspective
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Teshamae Monteith, MD
The study showed that orthostatic hypotension was associated with greater risks of both ischemic stroke and dementia, more so in those with hypertension and diabetes. This could be a consequence of small vessel disease and autonomic dysfunction.
The study results are interesting as it has been shown the more aggressive management of BP may reduce cognitive decline and dementia. Postural hypotension should be taken into consideration as more conservative BP guidelines are been developed for primary prevention.
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