Home-measured orthostatic hypotension associated with cerebral small vessel disease in a community-based older population

Abstract

This study aimed to investigate the relationship between cerebral small vessel disease (CSVD) and orthostatic hypotension (OH) using self-measured blood pressure at home in community-dwelling older subjects. Between May 2016 and October 2018, 663 community-dwelling adults aged ≥60 years were enrolled in Shandong, China. CSVD, including white matter hyperintensities (WMHs), lacunes, enlarged Virchow-Robin spaces (EVRS) and microbleeds, was assessed using brain magnetic resonance imaging. After receiving appropriate training, the subjects participated in "home-measured (H)OH" by themselves for three consecutive days. Participants were classified into no-HOH, 1 HOH, and ≥2 HOH episode groups according to the presence of HOH episodes. The WMH volume, WMH-to-total intracranial volume (TIV) ratio, total numbers of lacunes and EVRS, and prevalence of Fazekas scale score ≥2, lacunes, and EVRS were elevated in the 1 and ≥2 HOH episode groups compared with the no-HOH episode group (P < 0.05). The prevalence and total number of microbleeds were significantly higher in the ≥2 HOH episodes group than in the no-HOH and 1 HOH episode groups (P < 0.05). HOH episodes were significantly associated with WMH volume, WMH-to-TIV ratio, and the total numbers of lacunes, EVRS, and microbleeds after adjustment for confounders (P < 0.05). The risks of Fazekas scale score ≥2, lacunes, EVRS, and microbleeds were 2.123-, 1.893-, 2.162-, and 1.656-fold higher in the 1 HOH episode group and 4.910-, 5.359-, 3.048-, and 2.418-fold higher in the ≥2 HOH episodes group, respectively, than those in the no-HOH group. The presence of HOH episodes was an independent risk factor for CSVD in the community-based older population.

Keywords: Aging; Cerebral small vessel disease; Home-measured blood pressure; Orthostatic hypotension.