Hypotension and cognitive impairment among the elderly: Evidence from the CLHLS

Xidi Zhu; Zhicheng Luo; Gang Tian; Zhao Hu; Shaojie Li; Qing Mei Wang; Xun Luo; Lizhang Chen

doi:10.1371/journal.pone.0291775

Hypotension and cognitive impairment among the elderly: Evidence from the CLHLS

PLoS One. 2023 Sep 19;18(9):e0291775. doi: 10.1371/journal.pone.0291775. eCollection 2023.

Authors

Xidi Zhu^{1

2}, Zhicheng Luo¹, Gang Tian¹, Zhao Hu³, Shaojie Li⁴, Qing Mei Wang², Xun Luo^{5

6}, Lizhang Chen¹

Affiliations

¹ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
² Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the Teaching Affiliate of Harvard Medical School, Boston, Massachusetts, United States of America.
³ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.
⁴ School of Public Health, Peking University, Beijing, China.
⁵ Kerry Rehabilitation Medicine Research Institute, Shenzhen, China.
⁶ School of Medicine, Shenzhen University, Shenzhen, China.

Abstract

Background: While high blood pressure has been linked to cognitive impairment, the relationship between low blood pressure, especially hypotension, and cognitive impairment has not been well studied. Therefore, this study aimed to assess the prevalence of hypotension and cognitive impairment in the seniors of China, and the association between hypotension and cognitive function impairment.

Methods: The data was derived from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured by objective examination. The Chinese version of the Mini-Mental State Examination (CMMSE) was used to evaluate the cognitive impairment of the elderly. Generalized linear models were conducted to evaluate the association of hypotension with cognitive impairment.

Results: The prevalence of hypotension and cognitive impairment in the Chinese elderly were 0.76% and 22.06%, respectively. Participants with hypotension, lower SBP, and lower DBP, had odds ratios of 1.62, 1.38, and 1.48 for cognitive impairment, respectively. Besides, the CMMSE scores decreased by 2.08, 0.86, and 1.08 in the elderly with hypotension, lower SBP, and DBP, compared with those with non-hypotension, higher SBP, and DBP, respectively. Subgroup analyses showed that the association of cognitive impairment with hypotension was stronger in Chinese elderly who had decreased activity of daily living. Moreover, there was statistical evidence of a nonlinear dose-response relationship of SBP and DBP with cognitive impairment (Pnonlinear < 0.05).

Conclusion: Hypotension was a potential risk factor for cognitive impairment of the Chinese elderly, especially for those having decreased activity of daily living. Blood pressure management should be conducted to prevent them from cognitive impairment.

Copyright: © 2023 Zhu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Blood Pressure
Cognition
Cognitive Dysfunction* / epidemiology
Humans
Hypertension*
Hypotension* / complications
Hypotension* / epidemiology

Grants and funding

The author Xun Luo is supported by Shenzhen Science and Technology Innovation Program JCYJ20180305163652073. The author Xidi Zhu does one-year visiting research scholarship at Spaulding Rehabilitation Hospital and that is funded by Central South University Scholarship, China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.