Orthostatic hypotension and cognitive function: Cross-sectional results from the ELSA-Brasil study

Abstract

Background: The association between orthostatic hypotension (OH) and cognitive impairment is controversial, and most studies have investigated older white adults from Western Europe and the United States. Therefore, we investigated the association between OH and cognitive performance in a large and racially diverse sample of adults using cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods: OH was defined when systolic blood pressure decreased 20 mmHg and/or diastolic blood pressure decreased 10 mmHg from supine to standing position. We investigated the association between OH and composite global cognition, memory, verbal fluency (VF), and Trail Making Test z-scores, using multiple linear regression models. We also investigated the association of orthostatic hypertension and systolic blood pressure/diastolic blood pressure changes with cognitive performance, as well as the interaction between OH and compensatory heart rate after postural change on cognitive performance. Results: We evaluated 12,826 participants (mean age = 51.5 ± 9.0 years, 46% male, 53% white). Participants with OH (4% of the sample) had poorer z-scores for VF (β = -0.108, 95% confidence interval = -0.189; -0.025, p =.01) than participants without OH. Orthostatic hypertension was also associated with worse performance on the VF test (β = -0.080, 95% confidence interval = -0.157; -0.003, p =.04). Systolic blood pressure orthostatic change had a nonlinear association with VF. The interaction terms between OH and compensatory increase in heart rate for the Trail Making Test z-score (p =.09) was borderline significant, suggesting that participants who lack compensatory heart rate after postural change might have poorer performance. Conclusion: OH and orthostatic hypertension were associated with poorer performance on the VF test in participants from Brazil.