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Citation
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Alessandra F, Campese N, Goebel G, Ndayisaba JP, Eschlboeck S, Kaindlstorfer C, Raccagni C, Granata R, Bonuccelli U, Ceravolo R, Seppi K, Poewe W, Wenning GK. Neurology 2020; ePub(ePub): ePub. |
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Abstract
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OBJECTIVES: To assess the frequency of transient orthostatic hypotension (tOH) and its clinical impact in Parkinson's disease (PD), we retrospectively studied 173 PD patients and 173 age- and gender-matched controls with orthostatic intolerance, who underwent cardiovascular autonomic function testing under continuous non-invasive blood pressure (BP) monitoring.
METHODS: We screened for tOH (systolic BP fall ≥ 20mmHg or diastolic ≥10mmHg resolving within the 1st minute upon standing) and classic OH (cOH, sustained systolic BP fall ≥ 20mmHg or diastolic ≥10mmHg within 3 minutes upon standing). In PD patients, we reviewed the medical records of the 6 months preceding and following autonomic testing for history of falls, syncope and orthostatic intolerance.
RESULTS: tOH occurred in 24% of PD patients and 21% of controls, cOH in 19% of PD patients and in none of the controls, independently of any clinical-demographic or PD-specific characteristic. Forty percent of PD patients had a history of falls, in 29% of cases due to syncope. PD patients with history of orthostatic intolerance and syncope had a more severe systolic BP fall and lower diastolic BP rise upon standing, most pronounced in the first 30 to 60 seconds.
CONCLUSIONS: tOH is an age-dependent phenomenon, which is at least as common as cOH in PD. Transient BP falls when changing to the upright position may be overlooked with bedside BP measurements, but contribute to orthostatic intolerance and syncope in PD. Continuous non-invasive BP monitoring upon standing may help identify a modifiable risk factor for syncope-related falls in parkinsonian patients.
Language: en |