Twenty-Four Hour Non-Invasive Ambulatory Blood Pressure and Heart Rate Monitoring in Parkinson’s Disease

Abstract

Non-motor symptoms are now commonly recognized in Parkinson’s disease (PD) and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-Parkinsonian) drugs and can result in atypical blood pressure (BP) readings and related symptoms such as orthostatic hypotension (OH) and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT) or an (active) standing test (also known as Schellong test) in the laboratory, but 24 h ambulatory blood pressure monitoring (ABPM) in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary) is followed which will be discussed in this review. A 24-h ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR) can be obtained and establish whether or not a patient has a fall of BP at night (i.e., “dipper” vs. non-“dipper”). The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders, and obstructive sleep apnea, which are common in PD. Additionally, a 24-h ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 h ABPM in PD, summarize findings of such studies in PD, and briefly consider common daily stimuli that might affect 24 h ABPM.

Non-dipping nocturnal blood pressure and psychosis parameters in Parkinson disease

“…Low quality of sleep may cause non-dipping, due to agitation or similar symptoms of sleep deprivation, [14] which may furthermore cause psychosis. [22] Yet no difference in sleep duration for dippers vs. non-dippers was found in this study.…”

“…Furthermore, Lewy bodies can be found in autonomic regulatory areas, such as the parabrachial nucleus, neurons in paravertebral and paravertebral autonomic ganglia, hypothalamus. [42] Interestingly, the suprachiasmatic nuclei, which controls circadian rhythms in humans lies in the hypothalamus [14], whether this exact part of the hypothalamus is affected by lewy bodies remains unclear however. It is therefore possible that the above mentioned aspects of PD pathology in key autonomic and circadian areas of the brain might also affect circadian rhythm regulation of blood pressure.…”

“…The reasons for a blunted/reversed circadian blood pressure rhythm in PD can include several factors, including pathological entities, such as disorders of nocturnal movement, obstructive sleep apnea (OSAS), supine hypertension and reduced quality of sleep. [14] Numerous other factors can influence blood pressure profiles at night, such as getting up at night secondary to urinary urgency or nocturia (both common in PD).…”

“…[18] Other causes of psychosis could be low quality of sleep [22], which is however also likely to cause non-dipping. [14] Up to 90% of PD patients suffer from sleep disruption [23,24] which may be caused by the hallmark PD pathophysiology of dopamine depletion which plays a crucial role in sleep regulation and circadian homeostasis [23].…”

Effects of antihypertensive treatment on cardiovascular autonomic control: a prospective study

“…Tilt test is used traditionally for diagnosis of syncope (34,35) and orthostatic hypotension (36), study of sympathetic activity (37), study of the influence of various agents and factors on autonomic control (38), etc. Therefore, the use of tilt test for study of drug influence on autonomic regulation, including baroreflex, is appropriate.…”