Orthostatic hypotension in Parkinson's disease: Does it matter if asymptomatic?

Parkinsonism Relat Disord. 2016 Dec:33:65-71. doi: 10.1016/j.parkreldis.2016.09.013. Epub 2016 Sep 10.

Abstract

Introduction: Orthostatic hypotension (OH) may frequently be asymptomatic in patients with Parkinson's disease (PD). However, the relationship between symptomatic/asymptomatic status and functional disability remains unclear.

Methods: Using orthostatic blood pressure (BP) measurements and the Orthostatic Hypotension Symptom Assessment (OHSA) questionnaire, 121 consecutive PD patients without history of chronic hypertension and not taking alpha-adrenergic antagonists for bladder disorders were classified according to (1) OH symptomatic status, based on presence/absence of orthostatic symptoms (symptomatic OH: OHSA item 1 ≥ 1), and (2) OH severity, based on the magnitude of BP fall on the lying-to-standing test: OH- (<20/10 mmHg); moderate OH+ (≥20/10 mmHg but < 30/15 mmHg); and severe OH+ (≥30/15 mmHg). The primary endpoints were the activities of daily living/instrumental activities of daily living (ADL/iADL) and the Ambulatory Capacity Measure (ACM). Secondary endpoints included PD quality of life (PDQ-8) and prevalence of falls.

Results: The overall prevalence of OH+ was 30.6% (37/121 patients), with 62.2% symptomatic (23/37) and 37.8% asymptomatic (14/37). Symptomatic and asymptomatic OH + patients had similar impairments in ADL/iADL and ACM, significantly worse than OH- (p ≤ 0.035). There was a trend for worse ADL/iADL and ACM scores in severe OH + compared to moderate OH+, but both were worse than OH- (p ≤ 0.048). Symptomatic and asymptomatic OH + showed similar impairment in PDQ-8 and higher prevalence of falls compared to OH-.

Conclusions: Asymptomatic OH+ was associated with similar impairments in ADL/iADL and ACM than symptomatic OH+. These findings support screening for OH in PD patients regardless of postural lightheadedness.

Keywords: Autonomic; Orthostatic hypotension; Parkinson's disease; Supine hypertension; Syncope.

MeSH terms

  • Accidental Falls / statistics & numerical data
  • Activities of Daily Living
  • Adult
  • Aged
  • Aged, 80 and over
  • Antiparkinson Agents / therapeutic use
  • Autonomic Nervous System Diseases / etiology
  • Blood Pressure / physiology
  • Cohort Studies
  • Disability Evaluation
  • Female
  • Humans
  • Hypotension, Orthostatic / complications*
  • Hypotension, Orthostatic / drug therapy
  • Hypotension, Orthostatic / epidemiology*
  • Hypotension, Orthostatic / psychology
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Parkinson Disease / complications*
  • Parkinson Disease / drug therapy
  • Parkinson Disease / epidemiology*
  • Parkinson Disease / psychology
  • Quality of Life
  • Severity of Illness Index
  • Surveys and Questionnaires

Substances

  • Antiparkinson Agents