Data from: Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline

Objective: To examine associations between orthostatic hypotension (OH)
with dementia and long-term cognitive decline, and update previously
published results in the same cohort for stroke with an additional 16
years of follow-up. Methods: We analyzed data from 11709 participants
without a history of coronary heart disease or stroke who attended the
baseline exam (1987-1989) of the prospective Atherosclerosis Risk in
Communities (ARIC) study. OH was defined as a drop in systolic blood
pressure (BP) of at least 20 mmHg or a drop in diastolic BP of at least 10
mmHg, upon standing. Dementia was ascertained via examination, contact
with participants or their proxy, or medical record surveillance. Ischemic
stroke was ascertained via cohort-surveillance of hospitalizations, cohort
follow-up, and linkage with registries. Both outcomes were adjudicated.
Cognitive function was ascertained via three neuropsychological tests
administered in 1990-1992, 1996-1998, and a full battery of tests in
2011-2013. Scores were summarized and reported as standard deviations
(SDs). We used adjusted Cox regression and linear mixed models. Results:
Over approximately 25 years, 1068 developed dementia and 842 participants
had an ischemic stroke. Compared to persons without OH at baseline, those
with OH had a higher risk of dementia (HR=1.54, 95% CI 1.20-1.97) and
ischemic stroke (HR=2.08, 95% CI:1.65-2.62). Persons with OH had greater,
though non-significant, cognitive decline over 20 years (SD=0.09, 95%
CI:-0.02-0.21). Conclusions: OH assessed in midlife was independently
associated with incident dementia and ischemic stroke. Additional studies
are needed to elucidate potential mechanisms for these associations and
possible applications for prevention.