Ambulatory blood pressure monitoring and cardiovascular function tests in multiple system atrophy.
Cardiovascular tests (CT) of autonomic function and non-invasive ambulatory blood pressure (BP) and heart rate (HR) monitoring were performed in 17 patients with multiple system atrophy (MSA) (mean age 61 +/- 9 years) and in 12 healthy subjects matched for sex and age. CT showed severe autonomic dysfunction with orthostatic hypertension (OH) in eight patients with MSA (47%) (Group I). The remaining nine out of the 17 patients didn't show BP abnormalities during CT but an impaired HR reflex response was found (Group II). BP monitoring showed a reversed circadian BP rhythm in Group I with higher night-time than day-time values, a blunted circadian BP pattern in Group II and a normal day-night BP reduction in controls. Day-night HR reduction was poor in Group II and absent in Group I. Post-prandial hypotension was evaluated after a standard meal. In Group I systolic/diastolic BP fell within 30 minutes after meal (from 135 +/- 16/89 +/- 13 to 118 +/- 17/73 +/- 12 mmHg; p < 0.05) and after two hours had not returned to basal levels. In Group II a reduction of only systolic BP was found within 45 minutes after meal and persisted for one hour. OH clinically identifies a subgroup of MSA patients with a more severe BP dysregulation characterized by severe post-prandial hypotension and reversed circadian BP rhythm. CT and ambulatory BP monitoring are useful tools in identifying early stage of cardiovascular autonomic impairment.
Frongillo
D
D
Department of Internal Medicine, School of Cardiovascular Diseases, University Tor Vergata, Rome, Italy.
Stocchi
F
F
Buccolini
P
P
Stecconi
P
P
Viselli
F
F
Ruggieri
S
S
Cannata
D
D
D000328:Adult; D000367:Age Factors; D000368:Aged; D001284:Atrophy; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D018660:Blood Pressure Monitoring, Ambulatory; D002319:Cardiovascular System / Q000503:physiopathology*; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D002940:Circadian Rhythm; D004435:Eating; D005260:Female; D006334:Heart Function Tests; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012737:Sex Factors