Rapid Blood Pressure Drop During Middle-Age Increases Dementia Risk in Later Life

People in their middle-age who experience rapid drop in blood pressure are at a greater risk for dementia and cognitive decline later in life.

Highlights

Orthostatic or postural hypotension is a drop in blood pressures that occurs upon standing up suddenly.
A link has been established between orthostatic hypotension (OH) in middle-aged people and cognitive decline later in life.
This could be because temporary episodes of OH can have long-lasting consequences by reducing the blood flow to the brain.

Middle-aged people who experience temporary blood pressure drops that often cause dizziness upon standing up may be at an increased risk of developing cognitive decline and dementia 20 years later.

Research by Johns Hopkins Bloomberg School of Public Health suggest that these temporary episodes of drop in blood pressure known as orthostatic hypotension, may cause lasting damage by reducing the needed blood flow to the brain.

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‘People who suffered from orthostatic hypotension in their middle age were 40% more likely to develop dementia and 15% more likely to develop cognitive decline, later in life.’

Previous research has suggested a connection between orthostatic hypotension and cognitive decline in older people, but this appears to be the first to look at long-term associations.

Orthostatic hypotension is also known as postural hypotension. It is a decrease in blood pressure that causes dizziness or light-headedness, upon standing up from sitting or lying down.

An episode may last from a few seconds to minutes after standing up.

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"Even though these episodes are fleeting, they may have impacts that are long lasting," says study leader Andreea Rawlings, PhD, MS, a post-doctoral researcher in the Department of Epidemiology at the Bloomberg School.

"We found that those people who suffered from orthostatic hypotension in middle age were 40% more likely to develop dementia than those who did not. It's a significant finding and we need to better understand just what is happening." Rawlings added.

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Dementia affects an estimated 4-5 million Americans currently. There is no treatment for the condition and as the population ages, that number of affected is only expected to grow.

For the study, the researchers analyzed data from the Atherosclerosis Risk in Communities (ARIC) cohort, a study of 15,792 residents in four communities in the United States, who were between the ages of 45 and 64 when the study began in 1987.

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They focused on the 11,503 participants who were around 54 years old upon enrolling in the study and followed them for the next 20 or more years. They had no history of coronary heart disease or stroke. Their blood pressure was assessed upon standing, after 20 minutes lying down.

Orthostatic hypotension was defined as a drop of 20 mmHg or more in systolic blood pressure or 10 mmHg or more in diastolic blood pressure.

Around 6% of participants, or 703 people, met the definition.

People with orthostatic hypotension were 40% more likely to develop dementia than those who did not have it. They were seen to have 15% more cognitive decline.

Researchers say that the drop in blood pressure can cause temporary reduction in blood flow to the brain, and this could have lasting consequences.

But it was not clear whether orthostatic hypotension was an indicator of some other underlying disease or whether these participants had repeated problems with orthostatic hypotension over many years, as patients were not retested over time.

"Identifying risk factors for cognitive decline and dementia is important for understanding disease progression, and being able to identify those most at risk gives us possible strategies for prevention and intervention," Rawlings says. "This is one of those factors worth more investigation."

The study titled "Orthostatic Hypotension is Associated with 20-year Cognitive Decline and Incident Dementia: The Atherosclerosis Risk in Communities (ARIC) Study" was written by Andreea Rawlings; Stephen Juraschek; and other authors.

The findings were presented at the American Heart Association's EPI|LIFESTYLE 2017 Scientific Sessions in Portland.

Reference

Orthostatic hypotension (postural hypotension) - (http://www.mayoclinic.org/diseases-conditions/orthostatic-hypotension/basics/definition/con-20031255)

Source-Medindia