Orthostatic Hypotension in Parkinson Disease: How Much You Fall or How Low You Go?
ABSTRACT Orthostatic hypotension (OH) is frequent in patients with Parkinson's disease (PD) and can occur with or without symptoms. Pharmacological treatments are effective, but often exacerbate supine hypertension. Guidelines exist for the diagnosis, but not for the treatment of OH. We examine...
Saved in:
Published in | Movement disorders Vol. 30; no. 5; pp. 639 - 645 |
---|---|
Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Blackwell Publishing Ltd
15.04.2015
Wiley Subscription Services, Inc |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | ABSTRACT
Orthostatic hypotension (OH) is frequent in patients with Parkinson's disease (PD) and can occur with or without symptoms. Pharmacological treatments are effective, but often exacerbate supine hypertension. Guidelines exist for the diagnosis, but not for the treatment of OH. We examined the relationship between blood pressure (BP) and symptoms in a cohort of PD patients with the goal of identifying a hemodynamic target to guide treatment. We measured BP supine and upright (tilt or active standing) and identified the presence or absence of symptomatic OH by using a validated patient‐reported outcome questionnaire in 210 patients with PD. We evaluated the usefulness of the 20/10 and 30/15 mmHg diagnostic criteria (systolic/diastolic) to identify symptomatic OH. Fifty percent of the PD patient cohort met criteria for the 20/10 fall and 30% for the 30/15 BP fall. Among the patients who met either OH criteria, the percentage of those with symptoms was small (33% of those with 20/10 and 44% of those with 30/15 mmHg; 16% and 13%, respectively, overall). Symptomatic OH was associated with an upright mean BP below 75 mmHg. A mean standing BP <75 mmHg had a sensitivity of 97% and a specificity of 98% for detecting symptomatic OH. Although the prevalence of OH in PD is high, not all patients have symptoms of organ hypoperfusion. A mean standing BP below 75 mmHg appears to be a useful benchmark when deciding whether the benefits of initiating pharmacological treatment of OH outweigh the risks of exacerbating supine hypertension. © 2015 International Parkinson and Movement Disorder Society |
---|---|
Bibliography: | istex:0A651212571FB158D33ECA2BE59C5A5B60743EC5 ArticleID:MDS26079 National Institutes of Health and the Dysautonomia Foundation, Inc. ark:/67375/WNG-L0BSSMFQ-P Full financial disclosures and author roles may be found in the online version of this article. Clinical Autonomic Research Relevant conflicts of interest/financial disclosures Funding agencies J.‐A.P. receives research support from the Dysautonomia Foundation, Inc. L.N.K. receives research support from the National Institutes of Health (U54NS065736) and the Dysautonomia Foundation, Inc. J.M. receives research support from the Dysautonomia Foundation, Inc. H.K. serves on a scientific advisory board for Lundbeck; serves as editor‐in‐chief of and receives research support from the National Institutes of Health (U54NS065736 [principal investigator; PI]), the U.S. Food and Drug Administration (FD‐R‐3731‐01 [PI]), and the Dysautonomia Foundation, Inc. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 |
ISSN: | 0885-3185 1531-8257 |
DOI: | 10.1002/mds.26079 |