Relationship Between The Decline Of Orthostatic Blood Pressure And Cerebral White Matter Lesions In Elderly Population And Its Effect On Cognitive Function

ObjectivesWith the aging of society,the incidence of white matter lesions and the prevalence of cognitive dysfunction are increasing.Orthostatic hypotension(OH)has a high incidence in the elderly,which often leads to adverse events such as transient cerebral ischemia,syncope and falls.We aimed to investigated the association between the decline of orthostatic blood pressure and OH and white matter lesions,as well as its effect on cognitive function changes in the elderly.Methods407 outpatients or inpatients aged 60 years or above from Fujian Provincial Hospital in the period between September 2015 and December 2016 were included in this study.All subjects underwent magnetic resonance imaging(MRI)and orthostatic blood pressure assessments.The chi-square test was used to compare the prevalence of white matter lesions between the OH group and the non-OH group.The extent of periventricular hyperintensity(PVH)between the two groups was compared by MannWhitney U test.Ordinal logistic regression was applied to analyze the relationship between OH and the severity of white matter lesions.The degree of decline of orthostatic blood pressure were divided into tertiles,and the relationship between the decline of orthostatic blood pressure and the severity of white matter lesions were analyzed by ordinal logistic regression.We also included another 116 subjects aged over 60 years or above from inpatient department and diabetes club in Fujian Provincial Hospital between December 2015 and December 2016.All subjects completed orthostatic blood pressure measurement.Montreal cognitive assessment scale(MOCA)were performed to assess cognitive function at baseline and 2 years.Paired rank sum test was employed to compare the differences of MOCA score between in baseline and 2 years later.Binary logistic regression was used to analyze the effects of the decline of orthostatic blood pressure on cognitive function.Results1.The prevalence of white matter lesions in the OH group was higher than that in the non-OH group(94.6% vs 86.7%,P<0.05).The PVH score ranged from 1 to 4 points accounted for 27.2%,38.0%,8.7% and 20.7% in the OH group respectively,which accounted for 37.8%,32.7%,2.5% and 13.7% in the non-OH group.The extent of PVH in the OH group was higher than that in the non-OH group(P<0.01).2.The prevalence of OH in different PVH groups(PVH 0,1 and 2,3 and 4)was 10.6%,21.3% and 34.6%,respectively.The prevalence of OH showed an increasing trend with the increase of PVH score(P<0.05).3.After adjusting for potential confounders,binary logistic regression showed that the probability of white matter lesions in the OH group was 3.157 times higher than that in the non-OH group(P<0.05).Ordinal logistic regression analysis demonstrated that the severity of white matter lesions in the OH group was 2.061 times higher than that in the non-OH group(P<0.05).4.The degree of decline in orthostatic blood pressure were divided into tertiles.The severity of white matter lesions decreased significantly as the levels of reduced orthostatic blood pressure increased within the tertiles from Q1-Q3(All P<0.05).5.Ordinal logistic regression revealed that the probability of white matter lesions in Q1 group was 2.199 and 1.967 times higher than that in Q3 group in subjects with orthostatic systolic blood pressure(SBP)descending in 1 min and 3 min(all P<0.05).In subjects with orthostatic diastolic blood pressure(DBP)descending in 1 min and 3 min,the probability of white matter lesions was 1.951 and 1.946 times higher in Q1 group than that in Q3 group(All P<0.05).6.The degree of decline in orthostatic blood pressure were divided into the descending group and the non-descending group;The prevalence of cognitive function impairment was higher in the group of orthostatic SBP descending in 1 min and 3 min than that in the group of orthostatic SBP maintaining in 1 min and 3 min(All P<0.05).7.Binary logistic regression showed that the probability of cognitive function impairment was 3.692 and 3.234 times higher in the group of orthostatic SBP descending in 1 min and 3 min than those in the group of orthostatic SBP maintaining in 1 min and 3 min,respectively(All P<0.05).ConclusionsIn this study,the decline of orthostatic blood pressure was related to the severity of white matter lesions in the elderly.The cognitive impairment was more obvious in the decline of orthostatic SBP group after 2 years of follow-up.