Association of white mater lesions with orthostatic hypotension

Abstract

Objective: To reveal the cerebral hypoperperfusion characteristics of White matter lesions (WMLs), we monitored the blood pressure (BP) fluctuation in patients with orthostatic hypotension (OH) and WMLs.

Methods: A total of 2265 syncope patients were enrolled in this retrospective study. Clinical outcomes of brain MRI or CT, tilt test and continuous electrocardiogram monitoring were reviewed. All patients were divided into two groups according to WMLs status, and the WMLs group was further classified into three subgroups according to Fazekas grade (1-3). BP fluctuation in these subgroups was compared. The risk factors of WMLs and OH were determined by a multivariate logistic regression test.

Results: A total of 2265 syncope patients were enrolled, among which 56% patients were male. The average age of patients with WMLs was (61±12) years old. ΔTIME (Odds ratio [OR]: 1.014, 95% confidence interval [CI]: (1.005, 1.023), P=0.0015) and ΔSBP1 (OR: 0.990, 95% CI: (0.980, 1.000), P=0.0579) were demonstrated to be the risk factors of WMLs. The number of cases of repeated drops in blood pressure was twice as high as the cases with only drop in BP . The median and mean ΔSBP and ΔTIME of patients with WMLs were higher than those without WMLs. The incidence of diabetes, hypertension, age and Parkinson Plus Syndromes in patients with WMLs significantly decreased in comparison to those without WMLs (OR-diabetes: 2.558, OR-hypertension: 1.713, OR-age: 0.924 and OR-Parkinson Plus Syndromes: 0.476, P<0.05).

Conclusion: WMLs occurs in patients with hypoperfusion of recurrent OH. Vascular WMLs is associated with diabetes, hypertension, and age is at higher risk than WMLs associated with Parkinson Plus Syndromes.

Keywords: White mater lesions; orthostatic hypotension.

Figure 1

A (Time-angle): The X-axis was the time of tilt testing (minite), and the Y-axis was the angle of head-up tilt test; B (Time-BP mmHg): The X-axis was the time of tilt testing (minite), and the Y-axis was blood pressure. The three lines of the broken line diagram represented systolic blood pressure, mean blood pressure, and diastolic blood pressure. Blood pressure had decreased repeatedly and slowly.

Figure 2

A (Time-angle): The X-axis was the time of tilt testing (minite), and the Y-axis was the angle of head-up tilt test; B (Time-BP mmHg): The X-axis is the time of tilt testing (minite), and the Y-axis is blood pressure. The three lines of the broken line diagram represent systolic blood pressure, mean blood pressure, and diastolic blood pressure. Blood pressure had dropped one and only, then ΔTIME is zero.