Reverse blood pressure dipping as marker of dysautonomia in Parkinson disease

Milazzo, Valeria; Stefano, Cristina Di; Vallelonga, Fabrizio; Sobrero, Gabriele; Zibetti, Maurizio; Romagnolo, Alberto; Merola, Aristide; Milan, Alberto; Espay, Alberto J.; Lopiano, Leonardo; Veglio, Franco; Maule, Simona

doi:10.1016/j.parkreldis.2018.06.032

Cited by 47 publications

(28 citation statements)

References 30 publications

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“…Abnormal daily BP fluctuations in PD [33,34] have been associated with cardiovascular dysautonomia [34], but have rarely been reported in DLB. PD patients with this condition, including reduced or reverse nocturnal BP falls on ABPM, have also been found to have a higher prevalence of OH [33].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular dysautonomia and cognitive impairment in Lewy body disease

Oka

Umehara²,

Nakahara³

et al. 2019

Preprint

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Background Cognitive impairment may be correlated with cardiovascular dysautonomia, including blood pressure (BP) dysregulation, in Parkinson's disease (PD), but the association between these factors in dementia with Lewy bodies (DLB) is uncertain. This study aimed to clarify whether cardiovascular dysautonomia had an influence on cognitive function in Lewy body disease or not.Methods 99 patients with de novo PD (n=75) and DLB (n=24) were evaluated using the Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Cardiac 123Imetaiodobenzylguanidine (MIBG) scintigraphy, orthostatic hypotension (OH), supine hypertension (SH), postprandial hypotension (PPH), nocturnal BP fall in 24-hour ambulatory blood pressure monitoring (ABPM) and constipation were estimated. Associations of these factors with cognitive and executive dysfunction were examined. Results In DLB, MIBG uptake was reduced and OH, PPH and SH were severely disturbed, compared to PD. The nocturnal BP fall in ABPM was lower in DLB, and the failure of nocturnal BP fall in PD was associated with MMSE, after adjustment for other clinical features. FAB was significantly associated nocturnal BP fall, age and SH in PD, but no significant correlations among factors were found for DLB. Conclusion The significant association between nocturnal BP dysregulation and cognitive or executive decline in PD might be due to impaired microvascular circulation or invasion of α-synuclein in the CNS. The lack of a correlation of BP insufficiency with cognitive impairment in DLB suggests initial involvement of Lewy body pathology in the neocortex, regardless of Lewy body invasion of the autonomic nervous system.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular dysautonomia and cognitive impairment in Lewy body disease

Oka

Umehara²,

Nakahara³

et al. 2019

Preprint

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“…Adjusting blood pressure in PD patients always requires checking for possible disturbances in their circadian blood pressure regulation and for OH. Many PD patients, and in particular those affected by cardiovascular dysautonomia, are so-called non-dippers [13][14][15], meaning that they lack nocturnal blood pressure reduction. Once again this state has not yet been sufficiently explained.…”

Section: Diagnostics In Arterial Hypertensionmentioning

confidence: 99%

What are the considerations for anti-hypertensive treatment in patients with Parkinson’s disease?

Jost

2020

Expert Opinion on Pharmacotherapy

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“…Additionally, altered circadian BP patterns (most often a lack of the diastolic BP decrease during sleep) are prevalent in patients with autonomic failure, with studies reporting this finding in 66-90% of patients with PD, MSA, and pure autonomic failure [57-59]. Nocturnal ''reverse dipping'' patterns also are associated with autonomic failure in patients with PD [60]. Deviations from normal diurnal BP patterns are clinically important because of the relationship to poor cardiovascular outcomes and end-organ damage [61]; however, studies examining effects exclusively in patients with autonomic failure or PD populations are lacking.…”

Section: Supine Hypertensionmentioning

confidence: 99%

“…For example, patients with PD and similar autonomic failure disorders are prone to post-prandial hypotension [78,79]; thus, BP testing after meals isrecommended [9,10]. Additionally, 24-h ambulatory BP monitoring can identify supine hypertension and establish nocturnal BP patterns, including ''reverse dipping'' profiles [60].…”

Section: Screening and Diagnosismentioning

confidence: 99%

Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer

Cutsforth‐Gregory

Low

2019

Neurol Ther

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Parkinson disease (PD) is associated with a variety of motor and non-motor clinical manifestations, including cardiovascular autonomic dysfunction. Neurogenic orthostatic hypotension (nOH) is a potentially serious manifestation of cardiovascular sympathetic failure that occurs in approximately 30% of patients with PD. Here we review the pathophysiology and effects of the condition as well as treatment considerations for patients with PD and nOH. Screening for nOH using orthostatic symptom questionnaires, orthostatic blood pressure measurements, and specialized autonomic testing is beneficial for the identification of symptomatic and asymptomatic cases because cardiac sympathetic denervation and nOH can occur even at early (premotor) stages of PD. Symptoms of nOH, such as orthostatic lightheadedness, in patients with PD, have been shown to adversely affect patient safety (with increased risk of falls) and quality of life and should prompt treatment with nonpharmacologic and, occasionally, pharmacologic measures. Patients with nOH are also at increased risk of supine hypertension, which requires balancing various management strategies. Funding: Lundbeck (Deerfield, IL).

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Reverse blood pressure dipping as marker of dysautonomia in Parkinson disease

Abstract: Reverse nocturnal blood pressure dipping is a marker of cardiovascular dysautonomia in Parkinson disease, which can be screened for with ease and affordability using ambulatory blood pressure monitoring.

Cited by 47 publications

References 30 publications

Cardiovascular dysautonomia and cognitive impairment in Lewy body disease

Cardiovascular dysautonomia and cognitive impairment in Lewy body disease

What are the considerations for anti-hypertensive treatment in patients with Parkinson’s disease?

Neurogenic Orthostatic Hypotension in Parkinson Disease: A Primer

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