Postprandial hypotension in neurological disorders: systematic review and meta-analysis

Pavelić, Antun; Skorić, Magdalena Krbot; Crnošija, Luka; Habek, Mario

doi:10.1007/s10286-017-0440-8

Cited by 44 publications

(37 citation statements)

References 35 publications

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“…24 h-ABPM may also provide information on the severity of nOH during daily activity or after meals (“post-prandial hypotension” [56]), thus supporting customization of the therapeutic management [57]. …”

Section: Diagnostic Work-upmentioning

confidence: 99%

Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS)

et al. 2018

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PurposePatients suffering from cardiovascular autonomic failure often develop neurogenic supine hypertension (nSH), i.e., high blood pressure (BP) in the supine position, which falls in the upright position owing to impaired autonomic regulation. A committee was formed to reach consensus among experts on the definition and diagnosis of nSH in the context of cardiovascular autonomic failure.MethodsAs a first and preparatory step, a systematic search of PubMed-indexed literature on nSH up to January 2017 was performed. Available evidence derived from this search was discussed in a consensus expert round table meeting in Innsbruck on February 16, 2017. Statements originating from this meeting were further discussed by representatives of the American Autonomic Society and the European Federation of Autonomic Societies and are summarized in the document presented here. The final version received the endorsement of the European Academy of Neurology and the European Society of Hypertension.ResultsIn patients with neurogenic orthostatic hypotension, nSH is defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, measured after at least 5 min of rest in the supine position. Three severity degrees are recommended: mild, moderate and severe. nSH may also be present during nocturnal sleep, with reduced-dipping, non-dipping or rising nocturnal BP profiles with respect to mean daytime BP values. Home BP monitoring and 24-h-ambulatory BP monitoring provide relevant information for a customized clinical management.ConclusionsThe establishment of expert-based criteria to define nSH should standardize diagnosis and allow a better understanding of its epidemiology, prognosis and, ultimately, treatment.

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Section: Diagnostic Work-upmentioning

confidence: 99%

Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS)

et al. 2018

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“…Supine hypertension appears to be slightly more severe in MSA compared to PD (Pilleri et al, 2014; Schmidt et al, 2009a; Vichayanrat et al, 2017). In addition, AMBP can be useful to detect hypotensive episodes not found during a regular clinic visit, for example after meals (i.e., postprandial hypotension), and to further define treatment of OH and supine hypertension (Fanciulli et al, 2016; Gibbons et al, 2017; Jordan et al, 2002; Norcliffe-Kaufmann et al, 2014; Palma et al, 2017; Pavelic et al, 2017; Umehara et al, 2016). …”

Section: Autonomic Testingmentioning

confidence: 99%

Diagnosis of multiple system atrophy

Palma

Norcliffe‐Kaufmann

Kaufmann

2018

Autonomic Neuroscience

118

114

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Multiple system atrophy (MSA) may be difficult to distinguish clinically from other disorders, particularly in the early stages of the disease. An autonomic-only presentation can be indistinguishable from pure autonomic failure. Patients presenting with parkinsonism may be misdiagnosed as having Parkinson disease. Patients presenting with the cerebellar phenotype of MSA can mimic other adult-onset ataxias due to alcohol, chemotherapeutic agents, lead, lithium, and toluene, or vitamin E deficiency, as well as paraneoplastic, autoimmune, or genetic ataxias. A careful medical history and meticulous neurological examination remain the cornerstone for the accurate diagnosis of MSA. Ancillary investigations are helpful to support the diagnosis, rule out potential mimics, and define therapeutic strategies. This review summarizes diagnostic investigations useful in the differential diagnosis of patients with suspected MSA. Currently used techniques include structural and functional brain imaging, cardiac sympathetic imaging, cardiovascular autonomic testing, olfactory testing, sleep study, urological evaluation, and dysphagia and cognitive assessments. Despite advances in the diagnostic tools for MSA in recent years and the availability of consensus criteria for clinical diagnosis, the diagnostic accuracy of MSA remains sub-optimal. As other diagnostic tools emerge, including skin biopsy, retinal biomarkers, blood and cerebrospinal fluid biomarkers, and advanced genetic testing, a more accurate and earlier recognition of MSA should be possible, even in the prodromal stages. This has important implications as misdiagnosis can result in inappropriate treatment, patient and family distress, and erroneous eligibility for clinical trials of disease-modifying drugs.

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“…The prevalence of PPH among "healthy" older individuals is between 24% to 38% and it increases up to 91% in hospitalized elderly patients. (69,70). PPH has been associated with old age, autonomic dysfunction, falls, syncope, tabes dorsalis, Parkinson's disease, Alzheimer's disease, stroke, coronary artery disease, hypertension, diabetes mellitus, and increased frequency of all-cause mortality (1,15,(71)(72)(73)(74)(75)(76).…”

Section: Postprandial Hypotensionmentioning

confidence: 99%

Autonomic Neuropathy and Cardiovascular Disease in Aging

Shams

Morley

2018

The Journal of nutrition, health and aging

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Postprandial hypotension in neurological disorders: systematic review and meta-analysis

Abstract: The likelihood of having PPH is higher in patients with neurological diseases than in healthy controls. These findings should prompt further research focusing on the epidemiology and pathophysiology of PPH in different neurological diseases.

Cited by 44 publications

References 35 publications

Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS)

Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS)

Diagnosis of multiple system atrophy

Autonomic Neuropathy and Cardiovascular Disease in Aging

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