Orthostatic hypotension is associated with lower cognitive performance in adults aged 50 plus with supine hypertension
Open accessAbstract
OBJECTIVES: This study investigated the association between orthostatic hypotension (OH), supine hypertension (SH), and cognitive performance. METHODS: Four thousand six hundred and ninety participants of The Irish Longitudinal Study on Ageing (TILDA) were studied. SH was defined as systolic blood pressure (SBP) greater than or equal to 140 mmHg and/or diastolic blood pressure (DBP) greater than or equal to 90 mmHg, measured following supine rest (10 minutes). OH was defined as a sustained drop of greater than or equal to 20 mmHg SBP or greater than or equal to 10 mmHg DBP at 20, 30, 60, and 90 seconds following orthostasis. Cognitive performance tests assessed global function, executive function, processing speed, memory, and attention from which z-scores were computed. Multivariate adjusted analysis was performed comparing cognitive scores by OH status overall and in SH and non-SH groups separately. RESULTS: Thirty-nine percent had baseline SH (n = 1,868) and demonstrated a greater orthostatic fall in SBP (p < .0001) and DBP (p < .0001). This group had a higher prevalence of OH at all time-points, and scored lower in tests across all cognitive domains. No overall association between OH and cognitive performance was seen. However, SH subjects with OH scored significantly worse (adjusted) than SH subjects without OH, in domains of global cognition (30 seconds poststand β = -0.15; 99% confidence interval -0.29, -0.14; p = .004) and executive function (20 seconds poststand; β = -0.11; 99% confidence interval -0.22, -0.01; p = .006). There was also an indication toward lower cognition in all nonsignificant analyses. OH was not associated with cognitive performance in non-SH subjects. CONCLUSION: In conclusion, individuals with SH (defined as BP > 140/90 mmHg) coupled with OH measured using phasic BP had lower global and executive cognitive performance than those with SH but without OH.
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In patients with cognitive impairment, details of prodromal symptoms, whether loss of consciousness occurred, and symptoms after the event may be unreliable.
“In such circumstances, details of prodromal symptoms, whether or not LOC occurred, and symptoms after the event may be unreliable. 373,389,391-394”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [392]
The Results discuss orthostatic hypotension and cognitive performance, and the Assessment of Cognitive Function describes cognitive tests. Neither section addresses whether cognitively impaired patients can reliably report prodromal symptoms, loss of consciousness, or symptoms after an event. Searches for those event-history details found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAge-related memory impairment or more established forms of cognitive impairment are frequently associated with poor recall and therefore the lack of an accurate history of events.
“Age-related memory impairment or more established forms of cognitive impairment are frequently associated with poor recall and therefore the lack of an accurate history of events.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [392]
The Assessment of Cognitive Function section says the study measured episodic memory using word-recall and picture-memory tests. Neither it nor the retrieved Discussion passages addresses whether age-related or established cognitive impairment frequently causes poor recall of events or an inaccurate history. Searches for those terms and for unreliable self-reported histories found no supporting passage; page numbers were unavailable in our copy. (LLM, conf=0.73)
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- Authors
- Frewen, J., Finucane, C., Savva, G. M., Boyle, G., & Kenny, R. A.
- Affiliations
- Trinity College Dublin (IE)
- University of East Anglia (GB)
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-11-08
- Volume
- 69
- Issue
- 7
- Pages
- 878-885
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2140525089
- Cited by
- 76
- References
- 38
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 3 · 2020: 3 · 2019: 5 · 2018: 13 · 2017: 13 · 2016: 9 · 2015: 7 · 2014: 5
- FWCI
- 6.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- orthostatic hypotension, supine hypertension, cognitive performance, older adults, executive function, blood pressure, postural blood pressure, cognitive decline, Irish Longitudinal Study on Ageing
- MeSH terms
- Aged, Aging, Blood Pressure, Cognition, Female, Humans, Hypertension, Hypotension, Orthostatic, Ireland, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Supine Position
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