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Neurology. 2019 Oct 15;93(16):e1526-e1534. doi: 10.1212/WNL.0000000000008314. Epub 2019 Sep 16.

Orthostatic hypotension in Parkinson disease: A 7-year prospective population-based study.

Author information

1
From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway. ylva.hivand.hiorth@sus.no.
2
From the Department of Physical Medicine and Rehabilitation (Y.H.H.), The Norwegian Centre for Movement Disorders (Y.H.H., K.F.P., G.A.), Department of Neurology (K.F.P., G.A.), and Department of Research, Section of Biostatistics (I.D.), Stavanger University Hospital; Department of Clinical Medicine (O.-B.T.), University of Bergen; Department of Neurology (O.-B.T.), Haukeland University Hospital, Bergen; and Department of Chemistry, Bioscience and Environmental Engineering (G.A.), University of Stavanger, Norway.

Abstract

OBJECTIVE:

To determine the frequency, evolution, and associated features of orthostatic hypotension (OH) over 7 years of prospective follow-up in a population-based, initially drug-naive Parkinson disease (PD) cohort.

METHODS:

We performed repeated lying and standing blood pressure measurements in 185 patients with newly diagnosed PD and 172 matched normal controls to determine the occurrence of (1) OH using consensus-based criteria and (2) clinically significant OH (mean arterial pressure in standing position ≤75 mm Hg). We applied generalized estimating equations models for correlated data to investigate associated features of these 2 outcomes in patients with PD.

RESULTS:

OH was more common in patients with PD than controls at all visits, with the relative risk increasing from 3.0 (95% confidence interval [CI] 1.6-5.8; p < 0.001) at baseline to 4.9 (95% CI 2.4-10.1; p < 0.001) after 7 years. Despite a high cumulative prevalence of OH (65.4%) and clinically significant OH (29.2%), use of antihypotensive drugs was very rare (0.5%). OH was independently associated with older age (odds ratio [OR] 1.06 per year; 95% CI 1.03-1.10), lower Mini-Mental State Examination score (OR 0.91 [0.85-0.97] per unit), and longer follow-up time (OR 1.12 [1.03-1.23] per year). Clinically significant OH was associated with the same characteristics, in addition to higher levodopa equivalent dosage (OR 1.16 [1.07-1.25] per 100 mg).

CONCLUSIONS:

In this population-based study, we found OH to be a very frequent but undertreated complication in early PD, with associations to both disease-specific symptoms and drug treatment. Our findings suggest that clinicians should more actively assess and manage OH abnormalities in PD.

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