Orthostatic hypotension ups risk of cerebral small vessel disease

Delayed/prolonged orthostatic hypotension (DPOH) occurs more frequently than early orthostatic hypotension (EOH) among memory clinic patients, reveals a study.

Notably, longer duration and larger magnitude of blood pressure (BP) decline are associated with a higher burden of cerebral small vessel disease (CSVD), which is largely driven by high supine BP.

A total of 3,971 memory clinic patients (mean age 68 years, 45 percent female) from the Amsterdam Ageing Cohort and Amsterdam Dementia Cohort were included in this cross-sectional study. Of these, 42 percent had subjective cognitive complaints, 17 percent had mild cognitive impairment, and 41 percent had dementia.

EOH was defined as a BP drop of ±20 mm Hg systolic and/or 10 mm Hg diastolic only at 1 minute after standing and DPOH at 1 and/or 3 minutes after standing.

The research team used magnetic resonance imaging in 3,584 patients and computed tomography in 389 to assess the presence of CSVD (ie, white matter hyperintensities [WMH], lacunes, microbleeds).

EOH and DPOH had a prevalence of 9 percent and 18 percent, respectively. In age- and sex-adjusted logistic regression analyses, DPOH significantly correlated with higher burdens of WMH (odds ratio [OR], 1.21, 95 percent confidence interval [CI], 1.00‒1.46) and lacunes (OR, 1.34, 95 percent CI, 1.06‒1.69), but not microbleeds (OR, 1.22, 95 percent CI, 0.89‒1.67).

These associations weakened after adjusting for supine systolic BP (WMH: OR, 1.04, 95 percent CI, 0.85‒1.27; lacunes: OR, 1.21, 95 percent CI, 0.91‒1.62; microbleeds: OR, 0.95, 95 percent CI, 0.68‒1.31).

In addition, greater declines in systolic BP resulted in a higher risk of WMH and microbleeds, but this effect was lessened following the adjustment for supine systolic BP.

“OH, an impaired BP response to postural change, has been associated with cognitive decline and dementia, possibly through CSVD,” the researchers said.