Orthostatic hypotension is associated with lower cognitive performance in adults aged 50 plus with supine hypertension

This study investigated the association between orthostatic hypotension (OH), supine hypertension (SH), and cognitive performance. 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. 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. 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.