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Relationship of orthostatic blood pressure to white matter hyperintensities and subcortical volumes in late-life depression

  • Sean J. Colloby (a1), Akshya Vasudev (a1), John T. O'Brien (a1), Michael J. Firbank (a1), Steve W. Parry (a1) and Alan J. Thomas (a1)...



Structural brain abnormalities are associated with late-life major depression, with numerous studies reporting increased white matter hyperintensities (WMH) and reduced cortical/subcortical grey matter volumes. There is strong evidence linking vascular disease to WMH, but limited evidence on its association with subcortical volumes.


To investigate the relationship of orthostatic blood pressure changes to WMH and subcortical grey matter volumes in late-life depression.


Thirty-eight people with depression and a similarly aged comparison group (n = 30) underwent fluid attenuated inversion recovery (FLAIR) and T 1-weighted magnetic resonance imaging as well as systematic orthostatic blood pressure assessments. Volumetric estimates of WMH and subcortical grey matter were obtained for each participant and the relationship to blood pressure drop on active stand was examined.


An association between orthostatic systolic blood pressure drop and WMH volumes in temporal and parietal regions was found in the depression group (age-corrected partial correlation r’ = 0.31–0.35, P<0.05). Subcortical volumes were not related to blood pressure changes or WMH volumes in either group.


We found evidence for an association between the degree of orthostatic systolic blood pressure drop and WMH volume in the depression group. Since blood pressure drops lead to WMH in animals our findings suggest systolic blood pressure drops may be a factor contributing to these lesions in late-life depression.


Corresponding author

Dr Alan J. Thomas, Institute for Ageing and Health, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL, UK. Email:


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Relationship of orthostatic blood pressure to white matter hyperintensities and subcortical volumes in late-life depression

  • Sean J. Colloby (a1), Akshya Vasudev (a1), John T. O'Brien (a1), Michael J. Firbank (a1), Steve W. Parry (a1) and Alan J. Thomas (a1)...
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White matter hyperintensities and blood pressure in late-life depression

MOHINDER KAPOOR, ST6 Old Age Psychiatry
29 November 2011

Colloby et al 1 present an interesting paper in which an associationbetween the degree of orthostatic systolic blood pressure drop and white matter hyperintensities volume was found in the depressed people.

The authors rightly acknowledge their findings may have been confounded by the effects on blood pressure of antidepressant and antihypertensive drugs. They further go on state that although CIRS - G (cumulative illness rating scale for geriatrics) score was lower in the comparison group as compared to depression group; they don't think this had any effect on their findings. This is because CVRF (cerebrovascular risk factor) score was similar in both groups but difference in CIRS - G overall scores was caused solely by a difference in the incidence of urinary tract dysfunction in both groups. I think this difference in the incidence of urinary tract dysfunction in comparison and depression groupsmight have confounded the findings. We know certain genitourinary symptomsincluding incontinence, prostate problems and others could be treated withmedications that can cause orthostatic hypotension. 2,3 It appears the authors of this study might have overlooked some of the medication effectsapart from those mentioned in the study. They mention alpha-blockers (known to cause postural hypotension) were not used by anyone in this study but the data suggests some people from depression group were on Duloxetine. Duloxetine is used for depression and urinary incontinence in women and is known to cause postural hypotension. 4 We don't have any information about severity and treatment of urinary tract dysfunction and therefore one cannot rule out if this played any part in causing orthostatic systolic blood pressure drop more in depressed group.

Declaration of interest: None

References:1.Colloby S J et al. Relationship of orthostatic blood pressure to white matter hyperintensities and subcortical volumes in late-life depression. Br J Psychiatry 2011; 199: 404-410

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