Orthostatic hypotension, dizziness, neurology outcomes, and death in older adults, supplement methods & tables, STROND checklist

Objective To test the hypothesis that orthostatic hypotension (OH) might
cause cerebral hypoperfusion and injury, we examined the longitudinal
relationship between orthostatic hypotension (OH) or orthostatic symptoms
and incident neurologic outcomes in a community population of older
adults. Methods Cardiovascular Health Study (CHS) participants (≥65yrs)
without dementia or stroke had blood pressure (BP) measured after lying
20-minutes and after standing 3-minutes. Participants reported dizziness
immediately upon standing and any dizziness in the past 2wks. OH was
defined as a drop in standing systolic/diastolic BP ≥20/≥10mmHg. We
determined the association between OH or dizziness with (1) MRI brain
findings (ventricular size, white matter hyperintensities, brain infarcts)
using linear or logistic regression, (2) cognitive function (baseline and
over time) using generalized estimating equations, and (3) prospective
adjudicated events (dementia, stroke, death) using Cox models. Models were
adjusted for demographic characteristics and OH risk factors. We used
multiple imputation to account for missing OH or dizziness (N=534).
Results Prior to imputation, there were 5,007 participants (mean age
72.7±5.5yrs, 57.6% women, 10.9% black, 16% with OH). OH was modestly
associated with death (HR=1.11; 95%CI:1.02,1.20), but not MRI findings,
cognition, dementia, or stroke. In contrast, dizziness upon standing was
associated with lower baseline cognition (β=-1.20;-1.94,-0.47), incident
dementia (HR=1.32;1.04,1.62), incident stroke (HR=1.22;1.06,1.41), and
death (HR=1.13; 1.06,1.21). Similarly, dizziness over the past two weeks
was associated with higher white matter grade (β=0.16;0.03,0.30), brain
infarcts (OR=1.31;1.06,1.63), lower baseline cognition
(β=-1.18;-2.01,-0.34), and death (HR=1.13;1.04,1.22). Conclusions
Dizziness was more consistently associated with neurologic outcomes than
OH 3-minutes after standing. Delayed OH assessments may miss pathologic
information related to cerebral injury.