Autonomic cardiovascular regulation in Parkinson's disease by head-up tilt test - A cross-sectional study

Abstract

Background: Autonomic failure is an integral component of Parkinson's disease (PD), and orthostatic hypotension (OH) is commonly observed in advanced cases of PD. OH may be the result of underlying cardiovascular autonomic dysfunction or adverse effect of antiparkinsonian drugs. Patients may be asymptomatic during the early stage of disease but may have underlying cardiovascular dysautonomia which becomes obvious on stress. Most of the earlier studies used morphological and functional methods to evaluate cardiovascular autonomic control but were unable to evaluate during dynamic conditions. Aims and Objectives: The aim of the study was to evaluate cardiovascular autonomic disturbances in patients with PD using head-up tilt table test (HUTT). The objective of the study was to compare the spectral profile of heart rate variability (HRV) and blood pressure (BP) to orthostatic challenges using HUTT in patients with PD with healthy individuals. Materials and Methods: In this cross-sectional study, we have recorded continuous lead II ECG along with BP every 2 min in patients with PD and control group during HUTT for 10 min in supine, 45 min in 70° tilt and again 10 min in supine position which were later analyzed using Biopac software for HRV. Results: Symptoms indicating autonomic nervous system dysfunction were present in 65% (20) patients with PD. Postural dizziness was present in 20% (6) patients. After 5 min of tilt-up, increase in HR in patients with PD was lower than in controls. There was no significant change in diastolic BP (DBP) on tilting-up in patients with PD while DBP significantly increased in controls on tilting-up from73 ± 9 mm Hg to 80±11 mm Hg (P < 0.00001). The low frequency (LF) was not significantly changed in patients with PD, and it increased significantly in controls from 3.05 (2.28 to 4.70) ms 2 to 3.73 (2.69-5.03) ms

Heart Rate Variability Analyses in Parkinson’s Disease: A Systematic Review and Meta-Analysis

“…Eight studies stated that any medical disorder known to affect the autonomic nervous system was excluded [19,21,22,30,36,48,53,58]. Cardiovascular diseases, diabetes, and selected drugs were excluded in 13 studies [19,22,28,[31][32][33][34][35]43,45,55,58,63]. No exclusion criteria were reported in five studies [24,42,44,52,59].…”

“…The mean HFms 2 was 145.2 ± 41.1 ms 2 in PD patients and 219.4 ± 48.8 ms 2 in the healthy control group. Two studies had to be excluded [33,58] because the powers of ten differed by a factor of three to four. Accordingly, the values of these two studies were not considered plausible.…”

Cardiovascular history and risk of idiopathic Parkinson’s disease: a cross-sectional observational study

“…The shared risk factors between PD and CVD and the bidirectional relationship between the two conditions highlight the need of comprehensive management strategies targeting both neurological and cardiovascular health. To closely monitor patients, easy to perform tests like the Head-up tilt test to examine the heart rate variability could be measured during the clinical visits [ 34 ]. Additionally, at-home blood pressure diaries for patients before the clinical follow-up could help personalizing the treatment of these patients.…”