title: 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 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 <75 mmHg had a sensitivity of 97% and a specificity of 98% for detecting symptomatic OH. Although the prevalence of OH in PD is high, not all patients have symptoms of organ hypoperfusion. A mean standing BP below 75 mmHg appears to be a useful benchmark when deciding whether the benefits of initiating pharmacological treatment of OH outweigh the risks of exacerbating supine hypertension.
authors: Dysautonomia Center, Department of Neurology, New York University Medical Center, New York, New York, USA.
authors: Jose-Alberto
authors: JA
authors: Palma
authors: Juan Carlos
authors: JC
authors: Gomez-Esteban
authors: Lucy
authors: L
authors: Norcliffe-Kaufmann
authors: Jose
authors: J
authors: Martinez
authors: Beatriz
authors: B
authors: Tijero
authors: Koldo
authors: K
authors: Berganzo
authors: Horacio
authors: H
authors: Kaufmann
mesh_terms: D000367:Age Factors; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D005060:Europe; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000453:epidemiology; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa
keywords: autonomic failure; consensus criteria; dysautonomia; mean blood pressure; standing blood pressure; supine hypertension