Ambulatory blood pressure monitoring and cardiovascular function tests in multiple system atrophy

Abstract

Cardiovascular tests (CT) of autonomic function and non-invasive ambulatory blood pressure (BP) and heart rate (HR) monitoring were performed in 17 patients with multiple system atrophy (MSA) (mean age 61 +/- 9 years) and in 12 healthy subjects matched for sex and age. CT showed severe autonomic dysfunction with orthostatic hypertension (OH) in eight patients with MSA (47%) (Group I). The remaining nine out of the 17 patients didn't show BP abnormalities during CT but an impaired HR reflex response was found (Group II). BP monitoring showed a reversed circadian BP rhythm in Group I with higher night-time than day-time values, a blunted circadian BP pattern in Group II and a normal day-night BP reduction in controls. Day-night HR reduction was poor in Group II and absent in Group I. Post-prandial hypotension was evaluated after a standard meal. In Group I systolic/diastolic BP fell within 30 minutes after meal (from 135 +/- 16/89 +/- 13 to 118 +/- 17/73 +/- 12 mmHg; p < 0.05) and after two hours had not returned to basal levels. In Group II a reduction of only systolic BP was found within 45 minutes after meal and persisted for one hour. OH clinically identifies a subgroup of MSA patients with a more severe BP dysregulation characterized by severe post-prandial hypotension and reversed circadian BP rhythm. CT and ambulatory BP monitoring are useful tools in identifying early stage of cardiovascular autonomic impairment.

Loss of nocturnal blood pressure fall in various extrapyramidal syndromes

“…Others have already reported abnormal 24‐hour BP profiles in a similar percentage of PD and MSA, but not PSP patients. Plaschke et al, Frongillo et al, and Brevetti et al described abnormalities of BP profiles in smaller cohorts of PD and MSA patients 17–19. Senard et al were able to demonstrate that PD patients with orthostatic hypotension presented with higher nocturnal BP values which is in line with our findings 20.…”

The potential prognostic role of cardiovascular autonomic failure in α‐synucleinopathies

“…OH has been reported in up to 50% of DLB patients , but only 21% of patients in stage 3 of the Hoehn and Yahr scale refer to postural symptoms . Finally, symptoms of OH are found in almost 50% of MSA patients, already in the early stages of the disease , with peak cross‐sectional prevalence of 75% and 81% in European and American cohorts . Nevertheless, patients with a long‐term history of OH may undergo compensatory changes that ensure adequate cerebral perfusion even in the case of severe OH .…”

“…In dysautonomic patients, impairment of sympathetic output and consequent failure of activating counterbalance mechanisms [31] also produce PPH, which is commonly defined as a decrease in SBP 20 mmHg within 2 h after a meal [32]. Preliminary cross-sectional studies reported PPH in 48% of dysautonomic PD patients [33] and 47% of MSA patients [24]. Although PPH was associated with instrumental evidence of OH and NH in both cases, the small sample size may have created a bias in these studies.…”

Cardiovascular effects of domperidone in patients with Parkinson's disease treated with apomorphine

“…The method is also suitable in evaluation of orthostatic hypotension featuring hypotensive episodes in conjunction with standing, post‐prandial hypotension and reversal of the normal decline in blood pressure at night (8). It has previously been used in this connection in PD (9, 10) and multiple system atrophy (11).…”