title: Loss of nocturnal blood pressure fall in various extrapyramidal syndromes.
abstract: Cardiovascular autonomic dysfunction has frequently been reported in some patients with extrapyramidal syndromes, especially multiple system atrophy (MSA) but also Parkinson's disease (PD). However, there are only few reports on the prevalence of cardiovascular autonomic dysfunction progressive in supranuclear palsy (PSP). Moreover, the relation of detailed cardiovascular testing and easy to assess 24-hour ambulatory blood pressure (BP) is not known. Our study evaluates 24-hour ambulatory BP monitoring in patients with PD, PSP, MSA, and corresponding controls (Con) and relates the findings to the results of comprehensive cardiovascular autonomic testing. Twenty-three patients with PD, 25 patients with PSP, 25 patients with MSA, and 26 corresponding controls were studied by 24-hour ambulatory BP monitoring (ABPM) in comparison to cardiovascular autonomic testing. Patients with PD, PSP, and MSA presented frequently with a pathological nocturnal BP regulation (no decrease or even an increase of nocturnal BP) in comparison to the control group (PD 48%, PSP 40%, MSA 68% vs. Con 8%). In MSA and PD patients, the frequent pathological BP increase during night was closely correlated to orthostatic hypotension. Since loss of nocturnal BP fall is frequent in patients with extrapyramidal syndromes, even if they are free of subjective autonomic dysfunction, we recommend 24-hour ABPM as an easy to perform screening test, especially if detailed autonomic testing is not available. Pathological loss of nocturnal BP fall may account for increased cardiovascular mortality in extrapyramidal syndromes.
authors.affiliation: Autonomic and Neuroendocrinological Laboratory, University Clinic Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmidt
authors.forename: Daniela
authors.initials: D
authors.lastname: Berg
authors.forename: Silke
authors.initials: S
authors.lastname: Prieur
authors.forename: Susann
authors.initials: S
authors.lastname: Junghanns
authors.forename: Katherine
authors.initials: K
authors.lastname: Schweitzer
authors.forename: Christoph
authors.initials: C
authors.lastname: Globas
authors.forename: Ludger
authors.initials: L
authors.lastname: Schöls
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.forename: Tjalf
authors.initials: T
authors.lastname: Ziemssen
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology; D001480:Basal Ganglia Diseases / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D013494:Supranuclear Palsy, Progressive / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D018667:Tilt-Table Test