Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics.
Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes.
J Hypertens. 2023 Nov 1;41(11):1738-1744. doi: 10.1097/HJH.0000000000003525. Epub 2023 Aug 17.
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.
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).
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.
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.
体位性低血压（OH）是一种血压对体位变化反应受损的情况，与认知能力下降和痴呆有关，可能与脑小血管疾病（CSVD）有关。我们假设血压下降持续时间较长和血压下降幅度较大与 CSVD 风险增加相关。
这项横断面研究纳入了来自阿姆斯特丹老龄化队列和阿姆斯特丹痴呆队列的 3971 名记忆诊所患者（平均年龄 68 岁，45%为女性，42%有主观认知主诉，17%有轻度认知障碍，41%有痴呆）。早期 OH（EOH）定义为仅在站立后 1 分钟时收缩压下降 20mmHg 和/或舒张压下降 10mmHg；延迟/延长 OH（DPOH）定义为在站立后 1 分钟和/或 3 分钟时出现 OH。采用 MRI（n=3584）或 CT 脑成像（n=389）评估 CSVD[脑白质高信号（WMH）、腔隙、微出血]的存在。
EOH 的患病率为 9%，DPOH 的患病率为 18%。年龄和性别调整的逻辑回归分析显示，DPOH 而不是 EOH 与 WMH 负担增加（OR，95%CI：1.21，1.00-1.46）和腔隙（OR，95%CI 1.34，1.06-1.69）显著相关，但与微出血（OR，95%CI 1.22，0.89-1.67）无关。当调整仰卧位 SBP 后，这些关联减弱（WMH 的 OR，95%CI 为 1.04，0.85-1.27；腔隙的 OR 为 1.21，0.91-1.62；微出血的 OR 为 0.95，0.68-1.31）。SBP 下降幅度较大与 WMH 和微出血风险增加相关，但当调整仰卧位 SBP 后，这种影响减弱。
在记忆诊所患者中，DPOH 比 EOH 更常见。虽然 BP 下降持续时间较长和幅度较大与 CSVD 负担增加相关，但这些关联在很大程度上可以用较高的仰卧位 BP 来解释。
