A Study of Orthostatic Hypotension in Late-Life Depression

Objective: 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. Method: 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. Results: 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. Conclusions: 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. (Am J Geriatr Psychiatry 2009; 17: 996-999)