Published: 16-09-2021 15:28 | Updated: 16-09-2021 16:40

Postural hypotension in older adults related to poor cognition

Image by Gerd Altmann (Pixabay).

Postural hypotension, a drastic drop in blood pressure when standing up, is linked to an increased risk of dementia and accelerated progression from cognitive impairment to dementia, even in the absence of symptoms, for instance when feeling dizzy or faint. In a study published in the journal Hypertension, researchers from Karolinska Institutet show that postural hypotension could anticipate worse cognition in old age.

Postural hypotension has already been linked with falls and cardiovascular disease. The study further showed that postural hypotension, even asymptomatic, could anticipate worse cognition in old age.

Potential implications for the public

portrait of Xin Xia at ARC
Xin Xia. Photo: private

"Older adults should actively assess their postural blood pressure to detect this condition and implement a timely intervention," says Xin Xia, PhD student at the Aging Research Center, Departmant of Neurobiology, Care Sciences and Society, and co-author of the study.

This is particularly relevant since postural hypotension is usually asymptomatic, and many older adults with this condition may not seek medical help. The study shows that postural hypotension, even asymptomatic, appears to be harmful to cognitive function (for example memory and thinking) among older adults. This has potential implications for health care practice.

"Healthcare professionals should pay attention to the detection of postural hypotension and offer advice for timely intervention, if postural hypotension is detected", Xin Xia continues.

Population-based cohort study

The study used data from from the Swedish National study on Aging and Care in Kungshomen (SNAC-K), where approximately 2500 subjects (age ≥60 years) were regularly followed. At the beginning of the follow-up, the physicians measured the participants' blood pressure when they lie down and then when they stand up after lying down for five minutes. The drop in blood pressure was calculated when the participants stood up. The participants were then divided into two groups, one group with postural hypotension, and one without. The participants were followed for  approximately 12 years, period after which the dementia risk was compared between the two groups. Later on, the subjects were divided into three groups, one group without postural hypotension, one with symptom-free postural hypotension and one with symptomatic hypotension, and subsequently their dementia risk was compared.

What happens now?

Postural hypotension in older adults may reflect poor cardiovascular health, which is what Xin Xia's research project is focused on.

"In the next step, we plan to further evaluate if ideal cardiovascular health is related to better cognitive function and a reduced risk of dementia in older adults", Xin Xia concludes.

This study was supervised by Dr Chengxuan Qiu and colleagues.


From Normal Cognition to Cognitive Impairment and Dementia: Impact of Orthostatic Hypotension.
Xia X, Wang R, Vetrano DL, Grande G, Laukka EJ, Ding M, Fratiglioni L, Qiu C
Hypertension 2021 Sep;78(3):769-778