Pharmacology of orthostatic hypotension in Parkinson's disease: from pathophysiology to management.
Orthostatic hypotension is highly prevalent in the elderly, and affects up to 20% of patients with Parkinson's disease. Pharmacological approaches help to demonstrate that Parkinson's disease is a primary autonomic failure with involvement of the peripheral autonomic nervous system as shown by decreased [(123)I] meta-iodobenzylguanidine cardiac uptake and preserved growth hormone response to clonidine. No specific clinical trial has evaluated efficacy of antihypotensive drugs in Parkinson's disease. End point of treatment should be a reduction in postural symptoms. Midodrine (Proamatin), Roberts Pharmaceutical), a vasoconstrictor and fludrocortisone (Florinef), Bristol-Myers Squibb), a volume expander are first choice drugs. No data are available on their effects on orthostatic hypotension-related morbidity. The usefulness of other drugs remains to be demonstrated. This review will highlight the importance of nonpharmacological measures in the management of orthostatic hypotension in Parkinson's disease.
Pathak
Atul
A
Laboratoire de Pharmacologie Médicale et Clinique, INSERM U586, 37 allées Jules Guesde, 31073 Toulouse cedex, France.
Senard
Jean-Michel
JM
D000978:Antiparkinson Agents / Q000009:adverse effects; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D001810:Blood Volume / Q000187:drug effects; D004525:Efferent Pathways / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D019518:Postprandial Period / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000978:Antiparkinson Agents; D014662:Vasoconstrictor Agents