Blood pressure lability is associated with subcortical atrophy in early Parkinson's disease

Abstract

Objective: Increased cerebral white matter intensities associated with blood pressure (BP) lability were reported in patients with Parkinson's disease. However, this type of cardiovascular dysautonomia has seldom been associated with disruptions in deep gray matter structures in Parkinson's disease. In the present study, the associations between BP lability and subcortical deep gray matter structures in early Parkinson's disease were evaluated. Methods: The present study included 98 early nondemented Parkinson's disease patients. Supine and orthostatic BPs were measured using head-up tilt tests. BP variabilities, measured as standard deviations of 24-h daytime and nighttime BPs, were assessed using 24-h ambulatory BP monitoring. Every patient underwent brain MRI and measurement of deep gray matter volumes. The associations between BP lability and deep gray matter structures were analyzed. Results: Parkinson's disease patients with orthostatic hypotension had smaller volumes of striatum, particularly caudate, than patients without OH after adjusting for covariates of age, sex, disease duration, and Mini-Mental Status Examination score. Nocturnal BP variability was inversely associated with thalamus, hippocampus, and globus pallidus volumes. Conclusion: The results from the present study showed that BP lability was adversely associated with structural changes in early Parkinson's disease. Different forms of BP fluctuations influenced distinct deep gray matter structures.

Blood Pressure Patterns in Patients with Parkinson’s Disease: A Systematic Review

“…OH was associated with more severe PD disease [16,19,20], higher rates of depression [16,34], anxiety [20] and fatigue [20,24], as well as more severe cognitive impairment [16,19,20,24,42], autonomic dysfunction [16,20] and motor symptoms [16,20], although not all these results were reproduced by other studies. A couple of them found no significant differences in disease severity [21,26,28,33,41] or motor symptoms [19,21,41] between OH and non-OH group. PD patients with OH also had smaller volumes of the caudate and right anterior ventral and left posterior putamen in one study [19].…”

“…A couple of them found no significant differences in disease severity [21,26,28,33,41] or motor symptoms [19,21,41] between OH and non-OH group. PD patients with OH also had smaller volumes of the caudate and right anterior ventral and left posterior putamen in one study [19]. Moreover, in de novo untreated PD, OH correlated with carotid artery thickening [37].…”

“…It is curious that no subanalysis of PD patients with HBP was performed, therefore there is no available data regarding the interaction between HBP and OH in PD patients. In two studies, PD patients with OH had a slightly lower prevalence of HBP compared to non-OH patients (33.3% in OH vs. 49.2% in non-OH, p = 0.19; 21.7% in OH vs. 26.5% in non-OH, p = 0.53) [19,25], in other two studies there were opposite results (42.86% in OH vs. 38.61% in non-OH, p = 0.61; 38% in OH vs. 20% in non-OH, p = 0.04) [20,21], whereas another one reported equal prevalence of HBP among the two groups (p = 1) [28], which makes it difficult to draw conclusions regarding the association between HBP and OH. In one study, a group of 26 patients with untreated HBP without PD served as control group for PD patients without HBP, revealing higher left ventricular mass (indexed to body surface) in both HBP and reverse dipper PD compared to non-reverse dipper PD patients [17].…”

“…PD patients with higher BP fluctuations seemed to experience more commonly restless legs syndrome [38] and altered cognition in early PD stages [42]. Yoo et al [19] found that increased BP variability is also associated with deep gray matter changes (inversely correlated with thalamus, globus pallidus and hippocampus volumes) in patients with early PD. Another interesting finding is that normotensive BP patients have higher BP variability than control subjects, which further highlights the role of dysautonomia in altering the circadian rhythms [27].…”

“…Dipping status is detailed in Table 2 and Table S2. One study did not mention the definitions used for the dipper profile [19]. The pathological nocturnal profiles are reverse dipping, reduced dipping, and extreme dipping, described in 477 (40.46% of the patients evaluated for this), 310 (35.67%) and 23 (5.1%) subjects, respectively.…”