Cerebral microbleeds and blood pressure abnormalities in Parkinson's disease

Abstract

Blood pressure abnormalities are frequently observed in patients with Parkinson's disease (PD), and are associated with cerebrovascular diseases such as white matter hyperintensities and carotid atherosclerosis. We assessed the relationship between blood pressure abnormalities and cerebral microbleeds (CMBs), a marker of cerebral small vessel disease, in 128 patients with PD. We examined supine and orthostatic blood pressures and used 24-hour ambulatory blood pressure monitoring to assess the presence or absence of orthostatic hypotension (OH), supine hypertension (SH), nocturnal hypertension (NH), and loss of nocturnal blood pressure dips (non-dipping). CMBs were found in 13 (10.2%) patients, and the median number of CMBs was 1 (range: 1 to 10). Six of these patients had deep or infratentorial CMBs, six had strictly lobar CMBs, and one had mixed CMBs. Linear regression analysis indicated that presence of both OH and SH was independently associated with greater numbers of CMBs in deep or infratentorial regions, independent of age, sex, cardiovascular risk factors, and white matter hyperintensities. NH and non-dipping were not associated with CMBs in deep or infratentorial regions, and there was no association between blood pressure and CMBs in lobar regions. Our results suggest that the presence of both OH and SH may be related to deep or infratentorial CMBs in patients with PD.

Cerebral Microbleeds are Associated with Postural Instability and Gait Disturbance Subtype in People with Parkinson’s Disease

“…Anatomical analysis has revealed that deep CMB is more prevalent than lobar CMB. People with a history of hypertension and stroke are more likely to have CMBs, and the presence of deep or infratentorial CMB is associated with orthostatic hypotension and supine hypertension [15][16][17][18][19][20][21]. The present study demonstrated a higher prevalence of CMB in Taiwanese people with early-and mid-stage PD compared with previous studies, which may partially have resulted from the greater proportion of people with stroke history in the present study compared with those in other studies.…”

“…Approximately 15-20% of people with PD present CMBs [15][16][17][18][19][20][21]. In addition, the presence of a deep or infratentorial CMB is associated with hypertension, orthostatic hypotension, and a history of stroke.…”

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

“…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 ].…”

“…One study found that in patients with early PD and SH the motor symptoms and cognitive decline seemed to be worse compared to non-SH patients [ 42 ]. Moreover, SH was significantly correlated with restless legs syndrome [ 38 ], carotid artery thickening [ 37 ]/arterial stiffness [ 28 ] and an increased number of cerebral microbleeds in any brain region [ 25 ]. SH during sleep was shown to lead to NH, classified in 737 patients in our studies (38.91% of the patients investigated for NH).…”

The absence of orthostatic heart rate increase is associated with cognitive impairment in Parkinson’s disease

“…SH is often companied by OH in neurodegenerative disorders with autonomic dysfunction [ 19 ], and the neurogenic OH group showed a significantly higher prevalence of SH than no-OH and non-neurogenic OH in our cohort. Because CMBs are more abundant in cases of OH accompanied by SH than in OH without SH among PD patients [ 28 ], SH rather than OH may increase the susceptibility of end-organ damage and small vessel disease related to cognitive impairment in PD.…”