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Clin Auton Res. 2016 Apr;26(2):97-105. doi: 10.1007/s10286-015-0336-4. Epub 2016 Jan 22.

Supine hypertension in Parkinson's disease and multiple system atrophy.

Author information

1
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria. alessandra.fanciulli@i-med.ac.at.
2
Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Rome, Italy. alessandra.fanciulli@i-med.ac.at.
3
Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
4
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
5
Department of Heart and Great Vessels "A. Reale", "Sapienza" University of Rome, Rome, Italy.
6
Neurology and Stroke Unit, Department of Neurosciences, Azienda Ospedaliero, Universitaria Santa Maria, Terni, Italy.
7
Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Rome, Italy.
8
I.R.C.C.S Santa Lucia Foundation, Rome, Italy.

Abstract

OBJECTIVE:

Supine hypertension (SH) is a feature of cardiovascular autonomic failure that often accompanies orthostatic hypotension and may represent a negative prognostic factor in parkinsonian syndromes. Here we investigated the frequency rate as well as the clinical and tilt test correlates of SH in Parkinson's disease (PD) and multiple system atrophy (MSA).

METHODS:

197 PD (33 demented) and 78 MSA (24 MSA-Cerebellar, 54 MSA-Parkinsonian) patients who had undergone a tilt test examination were retrospectively included. Clinical-demographic characteristics were collected from clinical records at the time of the tilt test examination.

RESULTS:

SH (>140 mmHg systolic, >90 mmHg diastolic) occurred in 34 % of PD patients (n = 66, mild in 71 % of patients, moderate in 27 %, severe in 2 %) and 37 % of MSA ones (n = 29, mild in 55 % of patients, moderate in 17 %, severe in 28 %). No difference was observed in SH frequency between demented versus gender-, age- and disease duration-matched non-demented PD patients, or between patients with the parkinsonian (MSA-P) versus the cerebellar (MSA-C) variant of MSA. In PD, SH was associated with presence of cardiovascular comorbidities (p = 0.002) and greater systolic (p = 0.007) and diastolic (p = 0.002) orthostatic blood pressure fall. Orthostatic hypotension (p = 0.002), and to a lesser degree, lower daily dopaminergic intake (p = 0.01) and use of anti-hypertensive medications (p = 0.04) were associated with SH in MSA.

INTERPRETATION:

One-third of PD and MSA patients suffer from mild to severe SH, independently of age, disease duration or stage. In PD, cardiovascular comorbidities significantly contribute to the development of SH, while in MSA, SH appears to reflect cardiovascular autonomic failure.

KEYWORDS:

Multiple system atrophy; Orthostatic hypotension; Parkinson’s disease; Parkinson’s disease with dementia; Supine hypertension

PMID:
26801189
DOI:
10.1007/s10286-015-0336-4
[Indexed for MEDLINE]

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