24‐hour ambulatory blood pressure alterations in patients with Parkinson's disease

Abstract

Objects Abnormal blood pressure (BP) regulation is a feature of autonomic dysfunction in Parkinson's disease (PD) patients. The present study was to analyze the BP alterations by 24‐h ambulatory BP monitoring in PD patients with different disease stages and subtypes. Methods 32 consecutive patients PD patients and 43 control patients in our hospital from 2017 to 2020 were included. The circadian BP rhythm was divided into three types according to the 24‐h ambulatory BP monitoring. Dipping was defined as an average systolic BP (SBP) reduction during night‐time of 10%–19%. Reverse dipping was defined as an average increase in night‐time SBP values. The differences of the circadian BP rhythm and BP variability (BPV) were analyzed between PD group and the control group, the early PD group and the advanced PD group, as well as the tremor‐dominant group and the nontremor‐dominant group. Results There was statistical difference in circadian BP rhythm between PD group and control group (p < .05). There were statistical differences in circadian BP rhythm between the early PD group and the advanced PD group (p < .05). The mean values of night‐time SBP and diastolic BP (DBP) in the advanced PD group were higher than those in the control group and the early PD group (p < .05). The DBP CV in the advanced PD group was higher than that in the control group and the early PD group (p < .05). There was no significant difference of circadian BP rhythm, mean BP, and BPV between the tremor‐dominant and the nontremor‐dominant PD group after matching the disease duration. Conclusions Reverse dipping was more common in PD patients in this study, especially in the advanced PD patients. 24‐h ambulatory BP monitoring is an important method to evaluate the BP alterations in PD patients. Clinicians should be alert to reverse dipping in PD patients and intervene to prevent serious clinical events.

Neurodegenerative diseases and blood pressure variability: A comprehensive review from HOPE Asia

“…93,94 was significantly higher than in the early stage of the PD group and the normal group, also the differences between these groups in both BPV and circadian BP rhythm measurements were statistically significant, although there was no significant difference between the groups of PD with predominantly tremor or non-tremor; This can allow BPV examination to detect the progression of a stage of PD or various abnormalities related to BP before other symptoms develop. 90,95 It is also in line with the findings of high SBP that is significantly associated with a decline of UPDRS III (Unified Parkinson's Disease Rating Scale III) motor scores and becomes a predictor of motor decline in PD because of high SBP as the risk factors for white matter hyperintensities development which increases the rate of motoric disability. [96][97][98] However, controlling blood pressure with therapy, especially in PD patients with hypertension, will be more difficult due to BPV caused by fluctuations in BP due to autonomic dysfunction and neuropsychiatric disorders and sleep disorders as complications of PD that disrupt BP stability.…”

“…PD as a CNS neurodegenerative disease also has autonomic dysfunction due to cardiac sympathetic nerve degeneration, which accounts for about 40% of non‐motor symptoms of PD, which can even occur earlier before the onset of motor symptoms, with signs such as changes in BPV from OH and postprandial hypotension to supine hypertension 90–92 . A meta‐analysis of case‐control studies by Ng and coworkers in Asian populations, showed that hypertension increases the risk of PD by 1.9 times, but there are genetic and environmental factors that may influence it because, in the Caucasian population, hypertension was found to be a protective factor of PD 16 .…”

“…Autonomic dysfunction that occurs in PD is caused by a neuropathological process by abnormal deposits of α‐synuclein forming neuronal inclusions of Lewy body that are found in autonomic neurons in peripheral nerves and also in CNS, particularly in substantia nigra pars compacta (SNpc) and locus coeruleus (LC) causing neurodegeneration 93,94 . Shen and coworkers found that the BPV in the advanced stage of the PD group was significantly higher than in the early stage of the PD group and the normal group, also the differences between these groups in both BPV and circadian BP rhythm measurements were statistically significant, although there was no significant difference between the groups of PD with predominantly tremor or non‐tremor; This can allow BPV examination to detect the progression of a stage of PD or various abnormalities related to BP before other symptoms develop 90,95 . It is also in line with the findings of high SBP that is significantly associated with a decline of UPDRS III (Unified Parkinson's Disease Rating Scale III) motor scores and becomes a predictor of motor decline in PD because of high SBP as the risk factors for white matter hyperintensities development which increases the rate of motoric disability 96–98 .…”

Association between napping and 24-hour blood pressure variability among university students: A pilot study

“…There are some common indicators of BPV, including standard deviation (SD), range, coefficient of variation (CV), and average real variability (ARV) (2). BPV has been reported to be risk a factor or associated with the progression of many diseases (3)(4)(5)(6)(7). Among patients with Parkinson's disease (PD), 24 h CV of DBP in the advanced PD group was significantly higher than that in the control group and the early PD group (3).…”

“…BPV has been reported to be risk a factor or associated with the progression of many diseases (3)(4)(5)(6)(7). Among patients with Parkinson's disease (PD), 24 h CV of DBP in the advanced PD group was significantly higher than that in the control group and the early PD group (3). Also, BPV was found to be related to the severity of obstructive sleep apnea (OSA) (4).…”