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.