TY - JOUR
T1 - Orthostatic hypotension and its association with cerebral small vessel disease in a memory clinic population
AU - Wiersinga, Julia H. I.
AU - Rhodius-Meester, Hanneke F. M.
AU - Wolters, Frank J.
AU - Trappenburg, Marijke C.
AU - Lemstra, Afina W.
AU - Barkhof, Frederik
AU - Peters, Mike J. L.
AU - van der Flier, Wiesje M.
AU - Muller, Majon
N1 - Funding Information: We acknowledge the support from the Netherlands CardioVascular Research Initiative: the HBCx Dutch Heart Foundation (CVON 2018–28 & 2012–06 Heart Brain Connection), Dutch Federation of University Medical Centres, the Netherlands Organisation for Health Research and Development and the Royal Netherlands Academy of Sciences. Funding Information: Research of the Alzheimer's Center Amsterdam is part of the neurodegeneration research program of Amsterdam Neuroscience. The Vrije Universiteit Medical Center Alzheimer Center is supported by the Stichting Alzheimer Nederland and Stichting Vrije Universiteit Medical Center Fonds. The collaboration project Dementia diagnostics using Artificial Intelligence (DAILY; project number LSHM19123-HSGF) is co-funded by the public–private partnership allowance made available by Health-Holland, Top Sector Life Sciences and Health, to stimulate public–private partnerships and Combinostics. The chair of W.M.vdF. is supported by the Pasman Stichting. W.M.vdF. and H.F.M.R-M. are recipients of ABOARD, which is a public–private partnership receiving funding from ZonMW (number 73305095007) and Health-Holland, Top Sector Life Sciences and Health (public–private partnership allowance; number LSHM20106). W.M.vdF. is recipient of the EU Joint Programme - Neurodegenerative Disease Research (JPND) project EURO-FINGERS (ZonMW-Memorabel #733051102) which is supported through the following funding organizations under the aegis of Joint Programme-Neurodegenerative Disease: Finland, Academy of Finland; Germany, Federal Ministry of Education and Research; Spain, National Institute of Health Carlos III; Luxemburg, National Research Fund; Hungary, National Research, Development and Innovation Office; The Netherlands, Netherlands Organisation for Health Research and Development; Sweden, Swedish Research Council (grant agreement INTER/JPND/19/BM/14012609). H.F.M.R-M. is recipient of the Memorabel Dementia Fellowship 2021 (ZonMw projectnumber 10510022110004) and Alzheimer Nederland InterACT grant (projectnumber WE.08-2022-06). Publisher Copyright: Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - BACKGROUND: Orthostatic hypotension (OH), an impaired blood pressure (BP) response to postural change, has been associated with cognitive decline and dementia, possibly through cerebral small vessel disease (CSVD). We hypothesized that longer duration of BP drop and a larger BP drop is associated with increased risk of CSVD. METHODS: This cross-sectional study included 3971 memory clinic patients (mean age 68 years, 45% female, 42% subjective cognitive complaints, 17% mild cognitive impairment, 41% dementia) from the Amsterdam Ageing Cohort and Amsterdam Dementia Cohort. Early OH (EOH) was defined as a drop in BP of ±20 mmHg systolic and/or 10 mmHg diastolic only at 1 min after standing, and delayed/prolonged OH (DPOH) at 1 and/or 3 min after standing. Presence of CSVD [white matter hyperintensities (WMH), lacunes, microbleeds] was assessed with MRI ( n = 3584) or CT brain (n = 389). RESULTS: The prevalence of early OH was 9% and of delayed/prolonged OH 18%. Age- and sex-adjusted logistic regression analyses showed that delayed/prolonged OH, but not early OH, was significantly associated with a higher burden of WMH (OR, 95%CI: 1.21, 1.00-1.46) and lacunes (OR, 95%CI 1.34, 1.06-1.69), but not microbleeds (OR, 95%CI 1.22, 0.89-1.67). When adjusting for supine SBP, these associations attenuated (ORs, 95%CI for WMH 1.04, 0.85-1.27; for lacunes 1.21, 0.91-1.62; for microbleeds 0.95, 0.68-1.31). A larger drop in SBP was associated with increased risk of WMH and microbleeds, however, when adjusted for supine SBP, this effect diminished. CONCLUSIONS: Among memory clinic patients, DPOH is more common than EOH. While longer duration and larger magnitude of BP drop coincided with a higher burden of CSVD, these associations were largely explained by high supine BP.
AB - BACKGROUND: Orthostatic hypotension (OH), an impaired blood pressure (BP) response to postural change, has been associated with cognitive decline and dementia, possibly through cerebral small vessel disease (CSVD). We hypothesized that longer duration of BP drop and a larger BP drop is associated with increased risk of CSVD. METHODS: This cross-sectional study included 3971 memory clinic patients (mean age 68 years, 45% female, 42% subjective cognitive complaints, 17% mild cognitive impairment, 41% dementia) from the Amsterdam Ageing Cohort and Amsterdam Dementia Cohort. Early OH (EOH) was defined as a drop in BP of ±20 mmHg systolic and/or 10 mmHg diastolic only at 1 min after standing, and delayed/prolonged OH (DPOH) at 1 and/or 3 min after standing. Presence of CSVD [white matter hyperintensities (WMH), lacunes, microbleeds] was assessed with MRI ( n = 3584) or CT brain (n = 389). RESULTS: The prevalence of early OH was 9% and of delayed/prolonged OH 18%. Age- and sex-adjusted logistic regression analyses showed that delayed/prolonged OH, but not early OH, was significantly associated with a higher burden of WMH (OR, 95%CI: 1.21, 1.00-1.46) and lacunes (OR, 95%CI 1.34, 1.06-1.69), but not microbleeds (OR, 95%CI 1.22, 0.89-1.67). When adjusting for supine SBP, these associations attenuated (ORs, 95%CI for WMH 1.04, 0.85-1.27; for lacunes 1.21, 0.91-1.62; for microbleeds 0.95, 0.68-1.31). A larger drop in SBP was associated with increased risk of WMH and microbleeds, however, when adjusted for supine SBP, this effect diminished. CONCLUSIONS: Among memory clinic patients, DPOH is more common than EOH. While longer duration and larger magnitude of BP drop coincided with a higher burden of CSVD, these associations were largely explained by high supine BP.
KW - cerebral small vessel disease
KW - dementia
KW - hypertension
KW - orthostatic hypotension
UR - http://www.scopus.com/inward/record.url?scp=85173565398&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/HJH.0000000000003525
DO - https://doi.org/10.1097/HJH.0000000000003525
M3 - Article
C2 - 37589676
SN - 0263-6352
VL - 41
SP - 1738
EP - 1744
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 11
ER -