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BACKGROUND  In older persons, both high and low blood pressure (BP) levels are associated with symptoms of apathy. Population characteristics, such as burden of cerebral small‐vessel disease (CSVD), may underlie these apparently contradictory findings. We aimed to explore, in older persons, whether the burden of CSVD affects the association between BP and apathy.    DESIGN  Cross‐sectional study.    SETTING  Primary care setting, the Netherlands.    PARTICIPANTS  Community‐dwelling older persons (mean age = 80.7 years; SD = 4.1 years) with mild cognitive deficits and using antihypertensive treatment, participating in the baseline measurement of the magnetic resonance imaging substudy (n = 210) of the Discontinuation of Antihypertensive Treatment in the Elderly Study Leiden.    MEASUREMENTS  During home visits, BP was measured in a standardized way and apathy was assessed with the Apathy Scale (range = 0‐42). Stratified linear regression analyses were performed according to the burden of CSVD. A higher burden of CSVD was defined as 2 or more points on a compound CSVD score (range = 0‐3 points), defined as presence of white matter hyperintensities (greater than median), any lacunar infarct, and/or two or more microbleeds.    RESULTS  In the entire population, those with a lower systolic and those with a lower diastolic BP had more symptoms of apathy (β = −.35 [ P  = .01] and β = −.66 [ P  = .02], respectively). In older persons with a higher burden of CSVD (n = 50 [24%]), both lower systolic BP (β = −.64,  P  = .02) and lower diastolic BP (β = −1.6,  P  = .01) were associated with more symptoms of apathy, whereas no significant association was found between BP and symptoms of apathy in older persons with a lower burden of CSVD (n = 160).    CONCLUSIONS  Particularly in older persons with a higher burden of CSVD, lower BP was associated with more symptoms of apathy. Adequate BP levels for optimal psychological functioning may vary across older populations with a different burden of CSVD. J Am Geriatr Soc 68:1811‐1817, 2020.

Lower Blood Pressure, Small‐Vessel Disease, and Apathy in Older Persons With Mild Cognitive Deficits