title: Detecting nocturnal hypertension in Parkinson's disease and multiple system atrophy: proposal of a decision-support algorithm.
abstract: A pathological nocturnal blood pressure (BP) profile, either non-dipping or reverse dipping, occurs in more than 50% of subjects diagnosed with multiple system atrophy (MSA) or Parkinson's disease (PD). This may play a negative prognostic role in α-synucleinopathies, but, being mostly asymptomatic, remains largely underdiagnosed. In this proof-of-concept study, we aimed at developing a decision-support algorithm to predict pathological nocturnal BP profiles during a standard tilt-table examination in PD and MSA. Sixteen MSA and 16 PD patients underwent standard tilt-table examination and 24-h ambulatory BP monitoring (24-h ABPM). Clinical and tilt test differences between patients with a normal and a pathological nocturnal BP profile at 24-h ABPM were assessed, and a decision-support algorithm was developed accordingly. 75% of MSA and 31 % of PD patients showed a pathological nocturnal BP profile. This was associated with more pronounced orthostatic BP drop (p = 0.03), joint occurrence of orthostatic hypotension and supine hypertension (p = 0.046), and lack of BP overshoot in the late phase II (II_L, p = 0.002) and in the phase IV (p = 0.007) of the Valsalva manoeuvre. Combined ∆BP ≤0.5 mmHg in the II_L and ≤-7 mmHg in the IV phase of Valsalva manoeuvre correctly predicted a pathological nocturnal BP profile with 87.5% sensitivity and 85.7% specificity. Pathological nocturnal BP profiles are associated with evidence of cardiovascular noradrenergic failure in PD and MSA. The Valsalva manoeuvre is routinely performed during standard tilt-table examinations. We propose the naked-eye evaluation of Valsalva phase II_L and phase IV BP behaviour as time-sparing screening tool for pathological nocturnal BP profiles in PD and MSA.
authors.affiliation: Department of Neuroscience, Mental Health and Sensory Organs, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fanciulli
authors.forename: Stefano
authors.initials: S
authors.lastname: Strano
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Ndayisaba
authors.forename: Georg
authors.initials: G
authors.lastname: Goebel
authors.forename: Laura
authors.initials: L
authors.lastname: Gioffrè
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Rizzo
authors.forename: Carlo
authors.initials: C
authors.lastname: Colosimo
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Gregor K
authors.initials: GK
authors.lastname: Wenning
authors.forename: Francesco E
authors.initials: FE
authors.lastname: Pontieri
mesh_terms: D000368:Aged; D000465:Algorithms; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000502:physiology*; D003661:Decision Support Techniques; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications*; D010300:Parkinson Disease / Q000150:complications*; D018667:Tilt-Table Test; D014636:Valsalva Maneuver / Q000502:physiology
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