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.### 研究目标 探究体位性低血压（orthostatic hypotension, OH）与痴呆及长期认知衰退的关联，并基于同一队列新增16年的随访数据，更新此前已发表的脑卒中相关研究结果。 ### 研究方法 本研究分析了前瞻性社区动脉粥样硬化风险（Atherosclerosis Risk in Communities, ARIC）研究1987-1989年基线检查的11709名无冠心病或脑卒中病史的参与者数据。体位性低血压的定义为：站立时收缩压（blood pressure, BP）下降至少20mmHg，或舒张压下降至少10mmHg。痴呆通过临床检查、与参与者及其代理人的沟通或病历监测进行确认；缺血性脑卒中通过队列住院监测、队列随访及登记系统联动进行确认，两项结局均经终点审核。认知功能分别通过1990-1992年、1996-1998年实施的三项神经心理学测试，以及2011-2013年的全套神经心理学测试进行评估，测试得分经汇总后以标准差（standard deviations, SDs）形式报告。本研究采用校正后的Cox回归（Cox regression）与线性混合模型（linear mixed models）进行统计分析。 ### 研究结果 在约25年的随访期间，共有1068名参与者新发痴呆，842名参与者发生缺血性脑卒中。与基线无体位性低血压的参与者相比，基线存在体位性低血压的参与者痴呆发生风险更高（HR=1.54，95%CI：1.20~1.97），缺血性脑卒中发生风险也更高（HR=2.08，95%CI：1.65~2.62）。20年间，体位性低血压参与者的认知衰退程度更显著，但未达到统计学显著性（SD=0.09，95%CI：-0.02~0.21）。 ### 研究结论 中年时期检测到的体位性低血压与新发痴呆及缺血性脑卒中独立相关。未来仍需开展更多研究以阐明此类关联的潜在机制，并探索其在预防领域的潜在应用价值。