title: New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study.
abstract: OBJECTIVE
  Orthostatic hypotension (OH) is a key feature of multiple system atrophy (MSA), a fatal progressive neurodegenerative disorder associated with autonomic failure, parkinsonism and ataxia. This study aims (1) to determine the clinical spectrum of OH in a large European cohort of patients with MSA and (2) to investigate whether a prolonged postural challenge increases the sensitivity to detect OH in MSA.
  
  
  METHODS
  Assessment of OH during a 10 min orthostatic test in 349 patients with MSA from seven centres of the European MSA-Study Group (age: 63.6 ± 8.8 years; disease duration: 4.2 ± 2.6 years). Assessment of a possible relationship between OH and MSA subtype (P with predominant parkinsonism or C with predominant cerebellar ataxia), Unified MSA Rating Scale (UMSARS) scores and drug intake.
  
  
  RESULTS
  187 patients (54%) had moderate (> 20 mm Hg (systolic blood pressure (SBP)) and/or > 10 mm Hg (diastolic blood pressure (DBP)) or severe OH (> 30 mm Hg (SBP) and/or > 15 mm Hg (DBP)) within 3 min and 250 patients (72%) within 10 min. OH magnitude was significantly associated with disease severity (UMSARS I, II and IV), orthostatic symptoms (UMSARS I) and supine hypertension. OH severity was not associated with MSA subtype. Drug intake did not differ according to OH magnitude except for antihypertensive drugs being less frequently, and antihypotensive drugs more frequently, prescribed in severe OH.
  
  
  CONCLUSIONS
  This is the largest study of OH in patients with MSA. Our data suggest that the sensitivity to pick up OH increases substantially by a prolonged 10 min orthostatic challenge. These results will help to improve OH management and the design of future clinical trials.
authors.affiliation: Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France Unité INSERM U 1048 Eq 8, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Pavy-Le Traon
authors.affiliation: Faculty of Mathematics, Paul Sabatier University, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Piedvache
authors.affiliation: Department of Clinical Pharmacology, Clinical Investigation Center CIC 1436, University Hospital of Toulouse, University of Toulouse 3 and INSERM, Toulouse, France Faculty of Medical Sciences, UCA-BIOMED-CONICET, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Perez-Lloret
authors.affiliation: DIBINEM Alma Mater Studiorum-Università di Bologna, Bologna, Italy IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Calandra-Buonaura
authors.affiliation: Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France EuroMov, Laboratoire Movement to Health (M2H), Pôle Sommeil et Neurologie Clinique Beau Soleil, University of Montpellier, Montpellier, France.
authors.forename: V
authors.initials: V
authors.lastname: Cochen-De Cock
authors.affiliation: Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma, Roma, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Colosimo
authors.affiliation: DIBINEM Alma Mater Studiorum-Università di Bologna, Bologna, Italy IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cortelli
authors.affiliation: Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France.
authors.forename: R
authors.initials: R
authors.lastname: Debs
authors.affiliation: Department of Neurology, Medical University, Innsbruck, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Duerr
authors.affiliation: Department of Neurology, Medical University, Innsbruck, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Fanciulli
authors.affiliation: Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France Service de Neurologie, CHU de Bordeaux, Bordeaux, France Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Foubert-Samier
authors.affiliation: Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Gerdelat
authors.affiliation: Movement Disorders Unit, Department of Neurology, Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Gurevich
authors.affiliation: Department of Neurology, Medical University, Innsbruck, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Krismer
authors.affiliation: Division of Neurobiology, Medical University, Innsbruck, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Poewe
authors.affiliation: Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France Service de Neurologie, CHU de Bordeaux, Bordeaux, France Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Tison
authors.affiliation: Neurology department, University Hospital Hautepierre, Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Tranchant
authors.affiliation: Department of Neurology, Medical University, Innsbruck, Austria Division of Neurobiology, Medical University, Innsbruck, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Wenning
authors.affiliation: Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France Department of Clinical Pharmacology, Clinical Investigation Center CIC 1436, University Hospital of Toulouse, University of Toulouse 3 and INSERM, Toulouse, France.
authors.forename: O
authors.initials: O
authors.lastname: Rascol
authors.affiliation: Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France Service de Neurologie, CHU de Bordeaux, Bordeaux, France Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
authors.forename: W G
authors.initials: WG
authors.lastname: Meissner
mesh_terms: D001795:Blood Pressure Determination; D015331:Cohort Studies; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000453:epidemiology*
keywords: AUTONOMIC; MOVEMENT DISORDERS; MULTISYSTEM ATROPHY