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

Abstract

(1) Background: Cardiovascular autonomic dysfunction is a non-motor feature in Parkinson’s disease with negative impact on functionality and life expectancy, prompting early detection and proper management. We aimed to describe the blood pressure patterns reported in patients with Parkinson’s disease, as measured by 24-h ambulatory blood pressure monitoring. (2) Methods: We conducted a systematic search on the PubMed database. Studies enrolling patients with Parkinson’s disease undergoing 24-h ambulatory blood pressure monitoring were included. Data regarding study population, Parkinson’s disease course, vasoactive drugs, blood pressure profiles, and measurements were recorded. (3) Results: The search identified 172 studies. Forty studies eventually fulfilled the inclusion criteria, with 3090 patients enrolled. Abnormal blood pressure profiles were commonly encountered: high blood pressure in 38.13% of patients (938/2460), orthostatic hypotension in 38.68% (941/2433), supine hypertension in 27.76% (445/1603) and nocturnal hypertension in 38.91% (737/1894). Dipping status was also altered often, 40.46% of patients (477/1179) being reverse dippers and 35.67% (310/869) reduced dippers. All these patterns were correlated with negative clinical and imaging outcomes. (4) Conclusion: Patients with Parkinson’s disease have significantly altered blood pressure patterns that carry a negative prognosis. Ambulatory blood pressure monitoring should be validated as a biomarker of PD-associated cardiovascular dysautonomia and a tool for assisting therapeutic interventions.

Central Aortic Pressure and Arterial Stiffness in Parkinson’s Disease: A Comparative Study

“…In subgroup analysis, SBP and PP were significantly higher in the ARP group than in the TDP group. e ARP subtype may be more prone to cardiovascular disease than the TDP subtype, and this finding is in accordance with several other studies [21][22][23]. However, this issue is controversial, and there are a few reports on TDP subtypes with more severe impairment of the cardiac sympathetic system than the ARP subtypes; this was later negated in a slightly larger study by the same authors [24,25].…”

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

“…This may prone the patient with night-time high blood pressure uncovered therapeutically. 99,140 Other PD therapy, such as L-Dopa, dopamine agonist, or monoamine oxidase inhibitors, may also affect BP fluctuations. [149][150][151][152][153][154] It is suggested that some options such as levodopa sustained-release tablets, dopamine receptor agonists, continuous infusions of levodopa or dopamine agonists by intra-duodenal administration, or deep brain stimulation may avoid BP fluctuations.…”

“… 111 , 138 , 139 BP measurements must be cautious in PD patients, which might lead to wrong assumptions since the patients are susceptible to dysautonomia manifestations such as orthostatic hypotension, postprandial hypotension, or supine hypertension. 140 The BP decline preceding the onset of mild cognitive impairment and dementia may also lead to wrong assumptions; thus, it states the importance of comprehending the pathophysiology behind the issue. 36 , 123 , 124 As awareness and control are poor in most Asian countries/regions, the highlight must be put on educating about the importance of keeping normal blood pressure and reducing other risk factors related to it, such as reducing obesity and salt intake.…”

“…An accurate BP record, especially 24‐h blood pressure monitoring, is significant because it can analyze an individual's short‐ and long‐term BP fluctuations 111,138,139 . BP measurements must be cautious in PD patients, which might lead to wrong assumptions since the patients are susceptible to dysautonomia manifestations such as orthostatic hypotension, postprandial hypotension, or supine hypertension 140 . The BP decline preceding the onset of mild cognitive impairment and dementia may also lead to wrong assumptions; thus, it states the importance of comprehending the pathophysiology behind the issue 36,123,124 .…”

Turning Back the Clock in Parkinson’s Disease: Practical Recommendations for Managing Diurnal Symptom Worsening

“…[20] Of note, the reverse effect, patients functioning worse in the morning, may be observed in patients suffering from supine hypertension combined with orthostatic hypotension, a combination often seen as part of autonomic dysfunction in advanced Parkinson's disease. [21] The troughs in blood pressure resulting from orthostatic hypotension are typically most pronounced in the morning, not too long after rising from the bed.…”