A study of orthostatic hypotension in late-life depression

Studies examining vascular risk factors in depression report conflicting evidence but have not assessed orthostatic hypotension, a recently recognized risk factor for white matter hyperintensities.

The authors used noninvasive phasic orthostatic blood pressure monitoring to assess orthostatic hypotension in 17 subjects with late-life major depression and 17 comparison subjects. All received a neuropsychiatric assessment and standardized cardiovascular assessment.

The authors found a higher proportion of subjects met standard criteria for orthostatic hypotension in the depressed group (94% versus 65%, X = 4.5, df = 1, p = 0.034), and the degree of systolic blood pressure drop on standing was highly significantly greater in this group (t = 4.02, df = 32, p <0.001; mean drop of 46 mm Hg). Depressed subjects also experienced more clinical symptoms consistent with orthostatic hypotension.

Our findings suggest orthostatic hypotension may be an important factor in explaining the absence of an excess of clinically determined vascular risk factors in late-life depression.