Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study.
We studied a cohort of 1408 older subjects to explore whether postural changes in blood pressure (BP; defined as orthostatic hypo- or hypertension) can predict the onset of cognitive deterioration. Orthostatic hypotension was defined as a drop of 20 mm Hg in systolic or 10 mm Hg in diastolic BP and orthostatic hypertension as a rise of 20 mm Hg in systolic BP. Orthostatic BP values were grouped into quintiles for secondary analyses. Two cognitive assessments were considered: (1) cognitive impairment, that is, Mini-Mental State Examination scores ≤24/30, and (2) cognitive decline (CD), that is, a 3-point decrease in Mini-Mental State Examination score from the baseline to the follow-up. At the baseline, the prevalence of orthostatic hypotension and hypertension was 18.3% and 10.9%, respectively. At the follow-up (4.4±1.2 years), 286 participants were found cognitively impaired and 138 had a CD. Using logistic regression analysis adjusted for potential baseline confounders, participants with orthostatic hypertension were at significantly higher risk of CD (odds ratio =1.50; 95% confidence intervals =1.26-1.78). Neither orthostatic hypotension nor orthostatic hypertension raised the risk of developing a cognitive impairment. Using quintiles of orthostatic BP values, we found that both decreases and increases in systolic and diastolic BP raised the risk of CD, but not of cognitive impairment. In conclusion, we found that orthostatic hypertension predicts the onset of CD, but not of cognitive impairment in the elderly, whereas orthostatic hypotension predicts neither of these conditions. Further studies are needed to confirm our findings.
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.). ilmannato@gmail.com chiaracurreri@icloud.com.
Chiara
C
Curreri
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Valter
V
Giantin
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.). ilmannato@gmail.com chiaracurreri@icloud.com.
Nicola
N
Veronese
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Caterina
C
Trevisan
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Leonardo
L
Sartori
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Estella
E
Musacchio
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Sabina
S
Zambon
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Stefania
S
Maggi
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Egle
E
Perissinotto
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Maria Chiara
MC
Corti
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Gaetano
G
Crepaldi
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Enzo
E
Manzato
From the Department of Medicine DIMED, Geriatrics Division (C.C., V.G., N.V., C.T., E. Musacchio, G.S.), Department of Medicine DIMED, Clinica Medica I (L.S., E.M.), and Department of Cardiac, Thoracic and Vascular Sciences-Biostatistics, Epidemiology and Public Health Unit (E.P.), University of Padova, Padova, Italy; Department of Medicine, Washington University School of Medicine, St Louis, MO (S.Z.); National Research Council, Neuroscience Institute, Padova, Italy (S.Z., S.M., G.C., E. Manzato); and Health Care Planning and Evaluation Division of the Regione Veneto, Venice, Italy (M.C.C.).
Giuseppe
G
Sergi
D000368:Aged; D000375:Aging / Q000502:physiology / Q000523:psychology; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D007024:Hypotension, Orthostatic / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D007558:Italy / Q000453:epidemiology; D008297:Male; D009483:Neuropsychological Tests; D011187:Posture / Q000502:physiology; D015995:Prevalence; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment
blood pressure; cognition; cognitive impairment; elderly; orthostatic hypertension; orthostatic hypotension