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...

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Bibliographic Details
Published in:Movement disorders 2015-04, Vol.30 (5), p.639-645
Main Authors: Palma, Jose-Alberto, Gomez-Esteban, Juan Carlos, Norcliffe-Kaufmann, Lucy, Martinez, Jose, Tijero, Beatriz, Berganzo, Koldo, Kaufmann, Horacio
Format: Article
Language:English
Subjects:
Age Factors
Aged
Antiparkinson Agents - therapeutic use
autonomic failure
Blood Pressure - physiology
consensus criteria
dysautonomia
Europe
Female
Humans
Hypotension, Orthostatic - diagnosis
Hypotension, Orthostatic - epidemiology
Levodopa - therapeutic use
Male
mean blood pressure
Middle Aged
Movement disorders
Parkinson Disease - complications
Parkinson Disease - drug therapy
Prospective Studies
Sensitivity and Specificity
Severity of Illness Index
standing blood pressure
supine hypertension
Surveys and Questionnaires
United States
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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
ISSN:0885-3185
1531-8257
DOI:10.1002/mds.26079